Retrospective cohort study of primary care use and 90-day mortality among older adults undergoing cancer surgery

Multimorbidity and postoperative clinical decompensation are common among older surgical patients with cancer, highlighting the importance of primary care to optimize survival. A retrospective cohort study among patients of Duke University Health System (DUHS; Durham, NC) included 2566 older adults (≥ 65 years) undergoing surgery for colorectal, head and neck, prostate, ovarian, pancreatic, breast, liver, renal cell, non-small lung, endometrial, gastric, or esophageal cancer. Among these patients, 743 (28.9%) had no primary care practitioner (PCP) at the time of surgery. Compared with the PCP group, the no-PCP group had a higher 90-day postoperative mortality rate (2.0% versus 3.6%; p=0.03). Among the 823 patients with a PCP within DUHS, 400 (48.6%) had a primary care visit within 90 postoperative days. Patients with a postoperative primary care visit were more likely to be older, have a higher comorbidity burden, have an emergency department visit, and be readmitted. Nevertheless, they had a significantly lower 90-day postoperative mortality rate than those who did not have a primary care visit (0.3% versus 3.3%; p=0.001). The authors conclude that follow-up with primary care within 90 days after cancer surgery was associated with improved survival among onder adults.