Impact of Hospitalist Comanagement on Outcomes in the Vascular Surgery Inpatient Population

Abstract

Surgical comanagement with hospital medicine reduces mortality, increases patient satisfaction, and saves cost. Physicians can focus on their area of expertise, improving physician engagement. Comanagement is more prevalent in surgical specialties treating medically complex patients. The impact of comanagement has not been investigated thoroughly in vascular surgery. We sought to evaluate the impact of a strategic plan for comanagement of vascular surgery inpatients. The database at an academic medical center was queried for all admissions to vascular surgery between January 1, 2007 and December 31, 2017. In 2014, a hospitalist comanagement agreement was established to reduce surgical trainee workload, to improve outcomes, and to reduce cost. We collected data on demographics, comorbidities, length of stay, 30-day mortality, readmission, myocardial infarction (MI), and infection. Data were assessed to gauge impact on outcomes. There were 1438 admissions that met criteria for inclusion. Prevalence of comorbidities was 18.2% diabetes, 63.8% hypertension, 28.0% chronic kidney disease, and 46.7% coronary artery disease; mean age was 66.1 years, and 57.2% were male (similar in both groups). Mean length of stay was 8.2 days overall and 8.6 days before and 7.6 days after comanagement agreement (P = .0022), although logistic regression analysis revealed no significant difference. The 30-day mortality was 2.5%, similar in both groups. MI prevalence was 4.7%, significantly reduced with comanagement (2.6% vs 6.0%; P = .0028). Logistic regression modeling controlling for diabetes, hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease, and peripheral artery disease demonstrated a 56% reduction in odds of MI in patients who were comanaged (P = .008). Given the health care industry's focus on quality of care, surgical outcomes, cost containment, and physician engagement, surgical comanagement paradigms should be considered a strategy to accomplish these goals. Comanagement has resulted here in a significant reduction in adverse cardiac events. The population of vascular surgery patients, with its advanced age and often multiple comorbidities, is well suited to benefit from a collaborative working relationship between vascular surgeons and their hospital medicine colleagues. Further assessment of benefits of comanagement is warranted.