Surgical Comanagement by Hospitalists in Colorectal Surgery

Abstract

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 surgical comanagement (SCM) model in July 2014 at our institution, where the same 2 SCM hospitalists were dedicated to colorectal surgery year round. Each patient was screened daily by an SCM hospitalist for prevention and management of medical complications. Before SCM, hospitalists were typically consulted after medical complications had occurred. We conducted 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). We evaluated whether SCM by hospitalists improved outcomes of patients in colorectal surgery. There was no significant difference in medical complications, patient satisfaction, or 30-day readmission rate to our institution for medical cause with the SCM intervention. This intervention was associated with a significant decrease in the proportion of patients transferred to the ICU after rapid response team calls (relative risk [RR] 0.25 [95% CI 0.05 to 0.84], p= 0.039), proportion of patients with length of stay (LOS) ≥ 5 days (RR 0.73 [95% CI 0.64 to 0.83], p < 0.001), use of medical consultants (RR 0.75 [95% CI 0.63 to 0.89], p= 0.001), and the median direct cost of care by 10.3% (p= 0.0002). Surgical comanagement intervention was associated with a decrease in transfers to the ICU after rapid response team call, LOS, medical consultants, and the cost of care.