消化系统癌症手术前后医疗利用的轨迹分析

Trajectory Analysis of Healthcare Use Before and after Gastrointestinal Cancer Surgery

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS

影响因子:3.4

分区:医学2区 / 外科2区

发表日期:2025 Jan 01

作者: Muhammad Musaab Munir, Selamawit Woldesenbet, Timothy M Pawlik

DOI: 10.1097/XCS.0000000000001212

摘要

虚弱状态与术后预后不良和手术成本增加相关，但其对长期医疗利用的影响尚未明确。我们旨在评估消化系统癌症患者手术前后医疗利用的模式，并探讨与虚弱的关系。数据来自2005年至2020年的SEER-Medicare数据库，涵盖肝脏、胆道、胰腺、结肠和直肠癌患者的手术切除。通过基于索赔的虚弱指数评估虚弱程度。采用群体轨迹模型识别具有不同医疗利用模式的患者簇。多变量回归分析预测基于术前因素（包括虚弱）获得的簇类别。在66,684名受益者中，识别出4种不同的医疗利用轨迹，基于手术前后12个月的数据。在手术月出现利用高峰后，大部分患者恢复至手术前的基线水平（低：6,588人，占9.9%；中等：17,627人，占26.4%；高：29,850人，占44.8%）。然而，发现一条显著轨迹，涉及12,619名（18.9%）患者，手术促使其从“低”利用状态转变为“高”利用状态。虚弱患者更可能转变为高利用组（低：4.2% vs 转变：12.6% vs 高：7.5%；P<0.001）。多变量分析显示，虚弱与高利用轨迹显著相关（参照：最少和中等虚弱；最高：比值比4.90，95% CI 4.49-5.35；P<0.001）。消化系统癌症患者在手术后表现出不同的医疗利用簇。术前预测模型有助于区分不同的医疗利用轨迹，以个性化术后护理。

Abstract

Frailty correlates with worse postoperative outcomes and higher surgical cost, but the long-term impact on healthcare use remains ill-defined. We sought to evaluate patterns of healthcare use pre- and postsurgery among patients with gastrointestinal cancer and characterize the association with frailty.Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the SEER-Medicare database from 2005 to 2020. Frailty was assessed using the claims-based frailty index. Group-based trajectory modeling identified clusters of patients with discrete patterns of healthcare use. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty.Among 66,684 beneficiaries, 4 distinct use trajectories based on data from 12 months before and after surgical resection were identified. After a surge in use during the month of surgical resection, most patients reverted to presurgery baseline use (low: 6,588, 9.9%; moderate: 17,627, 26.4%; and high: 29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgical resection precipitated a transition from a "low" presurgery use state to a "high" use state postsurgery. Frail patients were more likely to be among those individuals who transitioned to high users (low: 4.2% vs transition: 12.6% vs high: 7.5%; p < 0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: odds ratio 4.90, 95% CI 4.49 to 5.35; p < 0.001).Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare use after surgical resection. Preoperative predictive models may help differentiate different healthcare use trajectories to help tailor care for patients in the postoperative period.