Trajectory Analysis of Healthcare Use Before and after Gastrointestinal Cancer Surgery

BACKGROUND: Frailty correlates with worse postoperative outcomes and higher surgical cost, but the long-term impact on healthcare use remains ill-defined. We sought to evaluate patterns of healthcare use pre- and postsurgery among patients with gastrointestinal cancer and characterize the association with frailty. STUDY DESIGN: Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the SEER-Medicare database from 2005 to 2020. Frailty was assessed using the claims-based frailty index. Group-based trajectory modeling identified clusters of patients with discrete patterns of healthcare use. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty. RESULTS: Among 66,684 beneficiaries, 4 distinct use trajectories based on data from 12 months before and after surgical resection were identified. After a surge in use during the month of surgical resection, most patients reverted to presurgery baseline use (low: 6,588, 9.9%; moderate: 17,627, 26.4%; and high: 29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgical resection precipitated a transition from a "low" presurgery use state to a "high" use state postsurgery. Frail patients were more likely to be among those individuals who transitioned to high users (low: 4.2% vs transition: 12.6% vs high: 7.5%; p < 0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: odds ratio 4.90, 95% CI 4.49 to 5.35; p < 0.001). CONCLUSIONS: Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare use after surgical resection. Preoperative predictive models may help differentiate different healthcare use trajectories to help tailor care for patients in the postoperative period.