初级保健 (PC) 对于整体健康和合并症管理至关重要。反过来，无法充分使用 PC 的患者可能会面临医疗保健差异。我们试图描述已建立的 PC 对接受消化道癌症手术的患者术后结果的影响。2005 年至 2019 年间诊断出肝胆癌、胰腺癌和结直肠癌的医疗保险受益人是在监测、流行病学和最终结果计划和医疗保险链接数据库。确定手术前 1 年内经历过 PC 的个体与未经历过 PC 的个体。术后教科书结果 (TO) 定义为无并发症、无延长住院时间、90 天内无再入院以及无死亡。在 63,177 名患者中，50,974 名患者 (80.7%) 在手术前至少接受过一次 PC 就诊。已建立 PC 的患者更有可能达到 TO（比值比 [OR]，1.14；95% 置信区间 [CI]，1.09-1.19），且并发症发生率较低（OR，0.85；95% CI，0.72-0.89），延长住院时间（OR，0.86；95% CI，0.81-0.94）、90 天再入院（OR，0.94；95% CI，0.90-0.99）和 90 天死亡率（OR，0.87；95% CI，0.79） -0.96）。此外，已接受 PC 治疗的患者的指数费用下降了 4.1%，1 年费用下降了 5.2%。值得注意的是，在手术前一年内进行 1 到 5 次 PC 就诊的患者 TO 的几率有所提高（OR，1.21；95% CI，1.16-1.27），而就诊超过 10 次的患者术后 TO 的几率较低（OR，0.91；95% CI，0.84-0.98）。大多数患有消化道癌症的 Medicare 受益人在手术前一年内已建立 PC。成熟的 PC 与实现理想结果和降低成本的可能性更高有关。相比之下，进行超过 10 次 PC 预约的患者（这可能是总体合并症负担的替代）术后结果没有改善。© 2024。作者。

Primary care (PC) is essential to overall wellness and management of comorbidities. In turn, patients without adequate access to PC may face healthcare disparities. We sought to characterize the impact of established PC on postoperative outcomes among patients undergoing a surgical procedure for a digestive tract cancer.Medicare beneficiaries with a diagnosis of hepatobiliary, pancreas, and colorectal cancer between 2005 and 2019 were identified within the Surveillance, Epidemiology, and End Results program and Medicare-linked database. Individuals who did versus did not have PC encounters within 1-year before surgery were identified. A postoperative textbook outcome (TO) was defined as the absence of complications, no prolonged hospital stay, no readmission within 90 days, and no mortality.Among 63,177 patients, 50,974 (80.7%) had at least one established PC visit before surgery. Patients with established PC were more likely to achieve TO (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.19) with lower odds for complications (OR, 0.85; 95% CI, 0.72-0.89), extended hospital stay (OR, 0.86; 95% CI, 0.81-0.94), 90-day readmission (OR, 0.94; 95% CI, 0.90-0.99), and 90-day mortality (OR, 0.87; 95% CI, 0.79-0.96). In addition, patients with established PC had a 4.1% decrease in index costs and a 5.2% decrease in 1-year costs. Notably, patients who had one to five visits with their PC in the year before surgery had improved odds of TO (OR, 1.21; 95% CI, 1.16-1.27), whereas individuals with more than 10 visits had lower odds of a postoperative TO (OR, 0.91; 95% CI, 0.84-0.98).Most Medicare beneficiaries with digestive tract cancer had established PC within the year before their surgery. Established PC was associated with a higher probability of achieving ideal outcomes and lower costs. In contrast, patients with more than 10 PC appointments, which was likely a surrogate of overall comorbidity burden, experienced no improvement in postoperative outcomes.© 2024. The Author(s).