Perioperative medicine platforms (PMPs) are being adopted by many hospitals and HMOs. Despite a growing body of evidence around pre operative medical optimization, the full impact of a dedicated preoperative consultation service on patient outcomes is unknown.
A merged clinical and administrative electronic database (Enterprise Data Warehouse) at a large urban academic medical center was queried to identity all adult patients who had hospital discharges from surgical services in 2008. For each hospitalization, the following information was obtained: patient age, surgeon, his/her department, length of stay, mortality (inpatient and at 6 month), subsequent 30‐day neadmission to the hospital, and whether the patient was seen by a PMP physician before the procedure, Charlson comorbidity scores were calculated, Multivariate mixed‐methods regression models were constructed to examine the risk‐adjusted effect of preoperative PMP consultation on the length of hospitalization, readmission rates and mortality.
Of the 10,226 nonobstetric surgical hospitalizations managed by 173 surgeons, 766 hospitalizations managed by 64 surgeons who had never referred patients to the PMP were excluded from the analysis. The remaining 9450 hospilalizations were evaluated. Consultation by a PMP physician was performed before surgery in 1702 of these hospitalizations (18.0%). Risk‐adjusted length of hospitalization was shorter by 0.9 days among those seen preoperatively by the PMP (P < 0.01). but the effect was predominantly among patients in the 2 higher tertiles of the Charlson comorbidity score (−0.8 days for the highest fertile, P = 0.01, and −0.9 days for the middle fertile, P < 0.01) compared with the lowest fertile, where reduction in days was not significant. Subanalysis by surgical specialty found significant reduction in hospitalization for patients admitted to spine surgery (−0.7 days, P < 0.01) and neurosurgery (−0.7 days. P < 0.01). The odds of rehospitalization and mortality were not significantly different among surgical patients between the exposure and control groups.
For medically complex surgical inpatients, preoperalive consultation by a dedicated PMP is associated with reduced lengths of stay without affecting the rate of rehospitalization or mortality.
K. Hinami, none; P. Kallas, none; D. Ferranti, none; J. Lee, none; M. Williams, none.
To cite this abstract:Hinami K, Kallas P, Lee J, Ferranti D, Williams M. A Dedicated Preoperative Medical Consultation Service May Shorten Length of Hospitalization among Medically Complex Surgical Patients. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 65. https://www.shmabstracts.com/abstract/a-dedicated-preoperative-medical-consultation-service-may-shorten-length-of-hospitalization-among-medically-complex-surgical-patients/. Accessed December 10, 2018.