Potential role of comanagement in "rescue" of surgical patients

Objectives: To evaluate the effect of medical comanagement on outcomes of hospitalized surgical patients who had postoperative complications. Study Design: Retrospective cohort study. Methods: We used clinical and administrative data at a large urban hospital to conduct a cohort study of select surgical hospitalizations in 2008 and 2009. We identified patients who suffered postoperative complications using measures developed by the University Health System Consortium. Bivariate and multivariate regression analyses were used to determine the associations of postoperative comanagement with inpatient mortality, length of stay, and cost in surgical patients who had postoperative complications. Results: From 21,728 total surgical hospitalizations, we identified 4040 hospitalizations involving primary procedures (mainly orthopedic and neurosurgical) that were associated with comanagement at least 25% of the time. After excluding cases with missing data, 501 hospitalizations (13.8%) involved a patient who suffered at least 1 postoperative complication. Patient characteristics between the comanaged (n = 297) and non-comanaged (n = 204) hospitalizations were well matched. Medical comanagement was associated with fewer in-hospital deaths (odds ratio 0.23, 95% confidence interval 0.05-0.99) in adjusted analysis. Comanaged compared with non-comanaged hospitalizations were associated with shorter stay (-2.6 days, P <.01) without significant differences in total cost. Conclusions: Comanagement of patients who had perioperative complications was associated with lower mortality, suggesting that comanagement may facilitate effective rescue among medically complex surgical patients.