To assess postacute care (PAC) facility use after inpatient cancer surgery among Medicare beneficiaries, identify factors associated with PAC use, and describe readmissions and days at home after discharge.
Approach:
Design and population: Cross-sectional study of fee-for-service Medicare claims from 2010 through 2022, including 1,477,585 beneficiaries undergoing inpatient cancer surgery.
Measures and analysis: PAC was discharge to a skilled nursing facility, inpatient rehabilitation facility, or long-term acute care hospital. Researchers used multivariable logistic regression to assess factors associated with PAC use and compared readmissions and days at home by dis…
Key Findings:
Overall, 16.0% of patients were discharged to PAC: 11.4% to skilled nursing facilities and 4.6% to inpatient rehabilitation facilities or long-term acute care hospitals.
PAC use was more likely among patients aged 80 years or older than those aged 65 to 69 years (adjusted odds ratio [AOR], 3.77; 95% CI, 3.71-3.83), those with a Charlson score of 3 or higher versus zero (AOR, 2.93; 95% CI, 2.89-2.97), patients with dual Medicar…
PAC use declined over time; the adjusted odds in 2022 were 0.57 times those in 2010 (95% CI, 0.55-0.58). Use varied by cancer type, with central nervous system cancers having the highest odds.
Thirty-day readmission was higher among patients discharged to PAC than among those discharged home (21.9% vs 9.5%; P < .001).
Median days at home during the 90 days after discharge were 68 (IQR, 47-77) for the PAC group and 90 (IQR, 90-90) for the home-discharge group (P < .001).
Interpretation:
The authors report that PAC use was associated with patient characteristics including older age, comorbidity, socioeconomic position, and advanced disease, and that PAC use and outcomes differed across cancer types and discharge destinations.
Limitations:
Claims data lacked detailed clinical information, including cancer staging, surgical approach, functional status, and social support.
Conclusion:
The authors conclude that PAC facility use is frequent among older adults undergoing cancer surgery and call for improved perioperative care models and targeted interventions to optimize recovery and reduce health care utilization.
