Background: Hospitalized vascular surgery patients typically have multiple severe comorbidities, poor functional status, and high perioperative cardiac risk and thus may be ideal patients for a collaborative care model.
Methods: During the 2-year pre-post study, 2431 patients were admitted to the vascular surgery service; 944 before comanagement and 1487 after, where a hospitalist actively participated in the medical care of American Society of Anesthesiologist Physical Status Classification scale 3 or 4 vascular surgery patients. Outcomes measured were in-hospital mortality, length of stay, 30-day readmission rate, pain scores, and patient safety metrics.
Results: With comanagement, mortality decreased from 2.01% to 1.00% (p=0.049), corresponding to a decrease in the risk-adjusted observed to expected mortality rate ratio from 1.22 to 0.53 (p=0.01). Patient reported pain scores were improved; more patients in the comanagement cohort expressed no pain (72 to 82.8% (p=0.01)) and there were reductions in mild (12.6 to 7.5% (p<0.001)) and moderate pain (13.1 to 7.6% (p<0.001)). There was an overall decrease in patient safety events (3.5 to 2.2 observed per 1000) (p=0.045)). Length of stay (LOS) increased from 5.1 to 6.1 days (p<0.001) though there was no significant difference in the observed to expected ratio, 0.83 to 0.88 (p=0.48). 30-day readmission rate was comparable (21.9 to 20.6% (p=0.44)).
Conclusions: After two years of implementation, our comanagement service reduced mortality, complications, and pain scores among high-risk vascular surgery patients.