Blog Post

Patients with Primary Care Get Better Results in Emergency Surgery

Surgeons Should Consider Primary Care Use in Patient Evaluations, LDI Experts Say

October 4, 2023

By:

Mackenzie Bolas

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When I moved to Philadelphia, I sought to establish new primary care, and was met with the stark reality of navigating the dwindling number of providers. After I struggled to find a center with open enrollment, I was given the first available appointment of January 12, 2024–four months after I called. It’s a disturbing conundrum that one of the largest cities in the U.S. is short on primary care doctors.

This is no trifling matter. Access to primary care is associated with positive health outcomes, and providers offer a source of early detection and treatment of disease, chronic disease management, and preventative care. Despite this, 65 million people, or nearly 20% of the U.S. population, live in primary care shortage areas. Locally in Philadelphia, about 1 in 6 adults reported not having a primary care provider.

How did we get here? Kaiser Family Foundation (KFF) reports that the percentage of primary care providers has fallen to 25%, “a tipping point beyond which many Americans won’t be able to find a family doctor at all.”

This shortage affects the health of millions of Americans. LDI Senior Fellows Stephanie Mayne, George Dalembert, Brian Jenssen, and Alexander Fiks found that children living in a neighborhood with increased access to primary care have more up-to-date vaccines along with a lower risk of depression and obesity.

In a new research study published in JAMA Surgery, LDI Senior Fellows Rachel Kelz, Elinore Kaufman, and their team, including senior author Sanford E. Roberts, sought to understand how primary care use affects patient outcomes after surgery. They studied a group of 102,384 Medicare patients over 66 years old that were hospitalized for emergency surgery, of which 88,340 patients had a primary care visit within 365 days of hospitalization.

Patients with access to primary care prior to their hospitalization exhibited better outcomes than those without it. Overall, individuals with primary care access had a 19% lower risk of in-hospital mortality and a 27% lower mortality risk at 30 days. This trend continued at 60, 90, and 180 days.

Protection Against Morbidity and Mortality

The team’s findings suggest that primary care may help protect against postoperative illness and death. This protective effect can be attributed to various factors, including a doctor managing related illnesses, optimizing the patient’s health before surgery, detecting new medical conditions early, and encouraging healthier lifestyle choices.

Identifying and Managing Comorbidities: Patients who had seen a primary care physician (PCP) had a higher prevalence of other illnesses. Effective management of these conditions in the outpatient setting may contribute to lower mortality rates.

Optimizing Health: When patients undergo an elective procedure, they consult with their physician to prepare and make sure they are in the optimal health pre-operation, in a process called perioperative optimization. When patients have emergency surgery, there is not the same opportunity. However, the study authors suggest accessing primary care improves perioperative optimization, because of the care already being provided.

Adherence to Recommended Care: Patients who survived 180 days and had primary care access were more likely to adhere to preventive screening recommendations for breast and colon cancer screenings. This finding suggests that patients compliant with screenings may also be more likely to follow physician recommendations and manage their chronic conditions effectively.

Citing the benefits of primary care for older Medicare beneficiaries, the study authors recommend that “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.”

Across the U.S., there is a push to increase access to primary care. At the federal level, the Centers for Medicare and Medicaid Services (CMS) is launching a campaign to restructure financing models and advance health equity through innovating primary care access. If successful, this campaign could change the future of preventive medicine.

The study, “Association of Established Primary Care Use With Postoperative Mortality Following Emergency General Surgery Procedures,” was published on July 19, 2023 in JAMA Surgery. Authors include Sanford E. Roberts, Claire B. Rosen, Luke J. Keele, Elinore J. Kaufman, Christopher J. Wirtalla, Caitlin B. Finn, Adora N. Moneme, Meenakshi Bewtra, and Rachel R. Kelz.