胃肠道癌手术前后的医疗保健轨迹分析
Trajectory Analysis of Healthcare Use Before and after Gastrointestinal Cancer Surgery
影响因子:3.40000
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
摘要
脆弱的术后结局和较高的手术成本相关，但对医疗保健使用的长期影响仍然不明显。我们试图评估胃肠道癌患者中医疗保健使用前和外科手术的模式，并表征了与肝脏，胆汁，胰腺，胰腺，结肠癌和直肠癌进行外科手术切除的患者的相关性。基于组的轨迹建模确定了具有离散医疗保健使用模式的患者簇。进行了多变量回归，以预测基于术前因素的聚类成员资格，包括脆弱的66,684名受益人，根据手术切除前和后12个月的数据，基于数据的4个不同的使用轨迹。在手术切除月份的使用中激增后，大多数患者恢复为治疗前基线使用（低：6,588，9.9％；中度：17,627，26.4％；高：29,850，44.8％）。然而，确定了涉及12,619名（18.9％）患者的著名轨迹，其中手术切除促使从“低”的预科前使用状态过渡到“高”使用状态术后手术。脆弱的患者更有可能是那些向高级使用者过渡的个人（低：4.2％vs过渡：12.6％vs High：7.5％； P <0.001）。在包含术前变量的多变量分析中，脆弱的群体轨迹成员资格（参考：最差和中等；最高：优势比4.90，95％CI 4.49至5.35; P <0.001; P <0.001）。患者与胃肠道癌显示出了外囊后使用的不同医疗保健临界值。术前预测模型可能有助于区分不同的医疗保健使用轨迹，以帮助术后为患者定制护理。
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.