Cross-sectional study of post-acute care facility utilization and outcomes among Medicare beneficiaries undergoing inpatient cancer surgery

Post-acute care (PAC) facility utilization is common among patients with cancer and has been associated with higher hospital readmission rates and mortality. Understandig which patients are most likely to require PAC following cancer surgery and how PAC use relates to postdischarge outcomes is critical to improving perioperative care and recovery. A cross-sectional study among 1 477 585 Medicare beneficiaries who underwent inpatient cancer surgery from 2010 through 2022 investigated discharge to a PAC facility after index hospitalization and within 3 days of discharge. The median age was 73 years (IQR 68-79); 48.5% were female; the most common cancer types were colorectal (28.4%), lung (14.5%), and prostate (11.8%); 23.3% had a Charlson score of 3 or higher. Overall, 16.0% of patients were discharged to a PAC facility. In multivariable analyses, factors associated with higher likelihood of PAC use included older age, higher comorbidity burden, and metastatic disease. PAC use decreased over time, with odds of use in2022 nearly half of that in 2010 (aOR 0.57; 95% CI 0.55-0.58). PAC use varied substantially by cancer type, with patients with central nervous system cancers having the highest odds of PAC utilization. Patients discharged to PAC facilities had substantially higher rates of 30-day hospital readmission than those discharged home (21.9% versus 9.5%; p<0.001). In addition, patients discharged to PAC facilities experienced fewer days at home in the 90 days following discharge (68 versus 90 days; p<0.001). The authors conclude that in this national cohort of Medicare beneficiaries undergoing inpatient cancer surgery, approximately 1 in 6 patients was discharged to a PAC facility. These patients had high rates of 30-day hospital readmissions and notably fewer days at home – a patients-centered measure reflecting both quality of life and health care utilization.