Primary care visits linked to decreased postoperative mortality rates

Editor's Note

Researchers from the University of Pennsylvania, Philadelphia, find lower mortality rates following emergency general surgery (EGS) in Black and White patients when exposed to primary care prior to the surgical procedure.

The retrospective cohort study included 102,384 Medicare patients aged 66 or older who were admitted from the emergency department for EGS between July 1, 2015 and June 30, 2018. 86.3% of patients had visited a primary care physician (PCP) in the year prior to their hospitalization.

Results:

• Patients with primary care exposure had 19% lower odds of in-hospital mortality than patients with no primary care exposure.
• At 30, 90, and 180 days after the procedure, patients with primary care exposure had about 27% less chance of mortality than those without exposure.
• Black patients with primary care exposure had similar odds of in-hospital mortality as patients without exposure.
• White patients who visited their PCP were 21% less at risk of in-hospital mortality.
• Both Black and White patients who visited their PCP were observed to have a lower risk of mortality than those who did not 30-, 90- and 180-days post-surgery.

“This association between primary care utilization and postoperative outcomes may be due to improved management of medical comorbidities; however, residual confounding from factors associated with health care-seeking behavior, such as exercise or good nutrition, must also be considered,” the authors conclude. “Surgeons should consider primary care use in their initial preoperative assessment and for patients who have not seen a PCP and perform a more comprehensive evaluation of the patient’s comorbidities and surgical readiness.”