ObjectiveIn recent years, hospitalists have been increasingly involved in the medical management of hospitalized surgical patients. This trend has been impacted by the goal of offloading inpatient care from the primary care provider in addition to the presence of an increasing burden of inpatient co-morbidities and broader trends in multi-disciplinary team-based care of the surgical patient. Multiple studies have demonstrated the clinical benefits associated with the implementation of a hospitalist co-management service for surgical patients, while others have highlighted increases in cost and strain on understaffed medical teams. We aimed to assess the impact of the implementation of a dedicated hospitalist co-management agreement on outcomes in an academic medical center vascular surgery inpatient service. MethodsInstitutional Review Board approval was obtained prior to data collection. The inpatient database was queried for all admissions to the vascular surgery service between January 1st, 2007 and December 31st, 2017. Given that a hospitalist co-management agreement was established in 2014, we collected data and compared cohorts admitted to the vascular surgery service before and after January 1, 2014. Patients admitted to the intensive care unit during their hospital stay were excluded, as the hospitalist team was not involved in intensive care unit patient care. We collected data on patient demographics, admission diagnosis, co-morbid diseases, and clinical outcomes including hospital length of stay, cardiac morbidity and mortality. Data was assessed via logistic regression models to investigate the impact on clinical outcomes after the start date of the hospitalist co-management program. ResultsA total of 1,438 patients were included in the analysis, including 866 pre- and 572 post hospitalist co-management agreement. Mean age was 66.1 (SD 14.0) years, similar in both groups. Overall, 822 (57.2%) of patients were male, and 616 (42.8%) were female, similar in both groups. Overall, 67.5% were White, 25.6% Black and 6.9% were classified as other race. Mean length of stay was 8.2 days overall and was lower in co-management group at 7.6 vs. 8.6 days in the non-co-management group (p=0.0022). Overall 30-day mortality was 2.5%, similar in both groups (p=0.36). The incidence of myocardial infarction was lower in the co-management group at 2.6% vs 6.0% in the non-co-management group (p=0.0001). Logistic regression modeling controlling for co-morbidities demonstrated a 61% odds reduction rate for cardiac events in patients who were co-managed by the hospitalist medicine team (p<0.01). Linear regression modeling showed an overall reduced length of stay in the co-management group by 1.45 days (p<0.01) with benefits shown specifically for patients undergoing major amputation, thromboembolectomy, and those with infected vascular grafts (3.8, 7.4, and 8.4 fewer days respectively). ConclusionsThe implementation of a hospitalist medicine co-management care system for vascular surgery inpatients was associated with a decrease in cardiac events and hospital length of stay. These findings encourage future investigation into additional clinical benefits and financial implications of hospitalist co-management in the vascular surgery inpatient population.