Purpose: To describe the characteristics of patients and outcomes of surgical comanagement performed by hospitalists in a general hospital in southern Brazil. Comanagement was performed when demanded by the surgical teams through consultory request. Retrospectively, from July 2014 to July 2015, electronic medical record review was done by trained team and experienced physician. Patients were followed until hospital discharge or death.
Description: During the period, 265 comanagements were requested, 21% being denied most often due to the need of transfer to the ICU. The average comanagement time by the hospitalist was 6 days (IIQ25-75% 3-11). About 50% of patients had more than one medical problem. Figure 1 shows the relative frequency of the medical problems warranting the comanagement request by the surgical teams. Fifty-four percent (54%) of patients were male, 80% were white, the median age was 66 years (57-74) and the median Charlson score was 4 (0-7). Figure 2 shows the percentage of resolutiveness by medical problem. Patients average hospitalization time was 42 days (27-73), the ICU transfer rate during the index hospitalization was 19% and the in-hospital death rate was 22%.
Conclusions: Perioperative patients are complex and must have their care well designed. As was already shown in relation to the USA, surgical comanagement by hospitalists seems to be efficient in Brazil as well. Our patients had a high hospital death rate and a high burden of disease. It suggests that surgical teams request comanagement for those evidently sick patients carrying the worse prognosis, what may decrease the potential benefit of such intervention. Therefore, we should probably use a systematic system to provide this model of care instead of expecting that surgeons will adequately select those patients who get the most benefit from comanagement. With the Hospital Medicine expansion in Brazil, more surgical patients will benefit from the shared care with clinicians. Further studies in other centers are needed in order to analyze the impact of surgical comanagement in different Brazilian Hospitals.