SURGICAL CO-MANAGEMENT BY HOSPITALISTS IN COLORECTAL SURGERY

Background: Patients with increasing age and medical complexity are undergoing colorectal surgery. Medical complications are not uncommon, and may contribute to higher mortality. We implemented a unique surgical co-management (SCM) model in July 2014 at our institution where two SCM hospitalists were dedicated to Colorectal surgery year round. Each patient was screened daily by a SCM hospitalist for prevention and management of medical complications. Prior to SCM, hospitalists were typically consulted after medical complications had occurred.
In this study, we describe if surgical co-management by hospitalists improved outcomes of patients in Colorectal surgery.

Methods: This is a pre-post study at an academic medical center with 938 patients in the pre-SCM group (July 2012 to June 2014), and 1,062 patients in the post-SCM group (July 2014 to May 2016).

For categorical variables, Chi-square and Fisher’s exact test were used to examine the association of patient characteristics between the pre- and post-SCM groups. For continuous variables, two sample t-test and Wilcoxon-Mann-Whitney test were used to examine the association of patient characteristics between the pre- and post-SCM groups.

For the multivariable analysis, backward stepwise regression model was applied for the selection of predictors, including age, sex, race, marital status, diagnosis-related group type, surgery type, admit source, discharge destination, case mix index, and direct cost. We estimated adjusted odds ratio from logistic regression if the outcome was binary and rare (<10%), or adjusted relative risk from poisson regression with a robust error variance (sandwich estimation).

Results: SCM intervention was associated with a significant decrease in the (a) proportion of patients with LOS ≥5 days (RR, 0.73 [95% CI, 0.64 to 0.83], P <0.001), (b) use of medical consultants (RR, 0.75 [95% CI, 0.63 to 0.89], P = 0.001), (c) proportion of patients transferred to intensive care unit after rapid response team calls (RR, 0.25 [95% CI, 0.05 to 0.84], P = 0.039), and (d) median direct cost of care by 10.3% (P = 0.0002).

There was no significant difference in the (a) number of medical complications, (b) patient satisfaction, or (c) 30-day readmission rate to our institution for medical cause.

Conclusions: SCM intervention was associated with a decrease in LOS, medical consultants, transfers to intensive care unit after rapid response team call, and the cost of care.