Primary care helps older patients live after emergency surgeries
Having a doctor may create ‘a protective effect’ in post-op, but is that a causative factor in patient recovery?
Primary care physicians are helping older patients live longer after emergency surgeries.
A new study found Medicare patients aged 66 years and older, and who had seen a primary care physician (PCP) in the past year, had lower mortality rates at 30, 60, 90, and 180 days after emergency surgeries for colorectal, intestinal, and abdominal issues. Seeing a primary care physician did not affect in-hospital mortality.
“The association of primary care exposure and postoperative mortality was substantial,” said the original investigation published in JAMA Surgery. “At 180 days, White patients had 34% lower odds of mortality and Black patients had 24% lower odds. These findings suggest that primary care may be exerting a protective effect on postoperative morbidity and mortality.”
Finding a PCP
The study noted 65 million people in the United States live in primary care shortage areas and almost 1/3 of Medicare patients need a primary care physician or clinician. Even if they had one, it is unclear if a doctor’s appointment itself is enough to affect postoperative mortality.
“As the authors point out, seeking preventive medical care is likely associated with other health behaviors,” said an invited commentary by Caroline E. Reinke, MD, MSHP, and David C. Slawson, MD. “What remains unanswered is whether the PCP visit itself is the causative factor associated with decreased mortality or if seeing a PCP on an annual basis is a marker of the patient possessing some other ‘magic sauce’ that improves outcomes?"
Researchers examined cases of 93,825 White patients and 8,559 Black patients from July 2015 to June 2018. Among them, 81,449 White patients and 6,891 Black patients had seen a primary care physician in the year prior to hospitalization.
Patients in the group that had seen a PCP in the year before surgery had higher rates of comorbidities in almost every condition, except for substance abuse, psychosis, seizure disorders, paralysis, and other neurological disorders. That was not necessarily surprising.
“Given that primary care visits are often a primary site for screening and diagnosis of chronic medical conditions, patients who regularly see their PCP are more likely to have comorbidities identified and documented than those who do not,” the study said.
Effectively managing those comorbidities may have contributed to lower rates of patient mortality after the surgeries, according to the study. The researchers cited examples of patients better managing hemoglobin A1C and blood pressure when they see a PCP.
Patients who survived 180 days also had greater rates of breast cancer, colon cancer, and cholesterol screenings than those who saw a PCP but died within 180 days. That suggested the patients were more compliant with physician recommendations in general, had better control of chronic conditions, or had less severe disease that required emergency surgery, according to the study.
The researchers noted patients willing to make primary care appointments may be more willing to seek medical care than those who did not have a PCP. Seeking medical care is likely associated with beneficial health behaviors, such as exercise and good nutrition, not captured in the study.
The researchers did not examine post-operative PCP visits, but noted that could be an subject for future study.
The research, “Association of Established Primary Care Use With Postoperative Mortality Following Emergency General Surgery Procedures,” and commentary, “Maintenance Matters and Compliance Conundrums – Optimization of Emergency General Surgery Outcomes in the Prehospital Phase of Care,” both were published in JAMA Surgery.