Clinical Scorecard: Postacute Care Use and Outcomes in Medicare Beneficiaries Hospitalized for Cancer Surgery
At a Glance
Category
Detail
Condition
Postacute care use and postdischarge outcomes after inpatient cancer-directed surgery
Key Mechanisms
Discharge to skilled nursing facilities, inpatient rehabilitation facilities, or long-term acute care hospitals; the study assessed associations with patient characteristics, readmissions, and days at home.
Target Population
1,477,585 fee-for-service Medicare beneficiaries undergoing inpatient cancer surgery from 2010 through 2022.
Care Setting
Inpatient cancer surgery and discharge to home or a postacute care facility, with outcomes assessed for 30 and 90 days after discharge.
Key Highlights
Overall, 16.0% of patients were discharged to a postacute care facility: 11.4% to skilled nursing facilities and 4.6% to inpatient rehabilitation facilities or long-term acute care hospitals.
Postacute care use was more likely among patients aged 80 years or older, those with a Charlson score of 3 or higher, patients with dual Medicare-Medicaid eligibility, and patients with metastatic disease.
Postacute care use declined over the study period; adjusted odds in 2022 were 0.57 times those in 2010.
Thirty-day readmission was 21.9% among patients discharged to postacute care facilities and 9.5% among those discharged home.
Median days at home during the 90 days after discharge were 68 for the postacute care group and 90 for the home-discharge group.
Guideline-Based Recommendations
Diagnosis
The study identified inpatient cancer surgery and postacute care discharge using Medicare claims; it did not evaluate diagnostic criteria for cancer.
Management
The authors suggest that findings may inform recognition of patients at elevated risk for postacute care placement and conversations about additional supports, including enhanced recovery after surgery protocols, geriatric comanagement, and targeted supportive care after discharge.
Monitoring & Follow-up
The study recorded hospital readmissions and days at home during the 30 and 90 days after discharge.
Risks
Postacute care facility discharge was associated with higher 30-day readmission and fewer days at home; these comparisons do not establish causation.
The authors note that incomplete information on staging, surgical approach, functional status, and social support may affect discharge destination and postdischarge outcomes.
Patient & Prescribing Data
Medicare beneficiaries continuously enrolled in fee-for-service Parts A and B from admission through 90 days after discharge or death; patients discharged to hospice were excluded.
This observational study evaluated discharge destination after cancer surgery, not a prescribed treatment. Postacute care facility use was associated with patient characteristics and differed by cancer type.
Clinical Best Practices
Consider the study's reported associations when identifying patients at elevated risk for postacute care placement; the analysis found higher use with older age, greater comorbidity, dual eligibility, and metastatic disease.
The authors identify enhanced recovery after surgery protocols, geriatric comanagement, and targeted supportive care after discharge as potential supports to discuss.
Interpret differences in readmission and days at home as observational associations, not evidence that postacute care placement caused these outcomes.
