Early primary care provider follow-up and readmission after high-risk surgery

Benjamin S. Brooke, David H. Stone, Jack L. Cronenwett, Brian Nolan, Randall R De Martino, Todd A. MacKenzie, David C. Goodman, Philip P. Goodney

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

IMPORTANCE Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. OBJECTIVE To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively. DESIGN, SETTING, AND PARTICIPANTS In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use.We stratified our analysis by the presence of complications during the surgical (index) admission. MAIN OUTCOMES AND MEASURES Thirty-day readmission rate. RESULTS Overall, 2619 patients (20.6%) undergoing open TAA repair and 4927 patients (9.3%) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6%) undergoing open TAA repair and 4528 patients (8.6%) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0%(without follow-up) to 20.4%(with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4%with follow-up vs 21.9%without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18%lower likelihood of 30-day readmission (odds ratio, 0.82; 95%CI, 0.71-0.96; P = .02), whereas no significant difference was found among patients after VHR. CONCLUSIONS AND RELEVANCE Follow-up with a PCP after high-risk surgery (eg, open TAA repair), especially among patients with complications, is associated with a lower risk of hospital readmission. Patients undergoing lower-risk surgery (eg, VHR) do not receive the same benefit from early PCP follow-up. Identifying high-risk surgical patients who will benefit from PCP integration during care transitions may offer a low-cost solution toward limiting readmissions.

Original languageEnglish (US)
Pages (from-to)821-828
Number of pages8
JournalJAMA Surgery
Volume149
Issue number8
DOIs
StatePublished - 2014
Externally publishedYes

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Primary Health Care
Ventral Hernia
Thoracic Aortic Aneurysm
Herniorrhaphy
Patient Transfer
Patient Readmission
Medicare
Ambulatory Surgical Procedures
Odds Ratio
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Brooke, B. S., Stone, D. H., Cronenwett, J. L., Nolan, B., De Martino, R. R., MacKenzie, T. A., ... Goodney, P. P. (2014). Early primary care provider follow-up and readmission after high-risk surgery. JAMA Surgery, 149(8), 821-828. https://doi.org/10.1001/jamasurg.2014.157

Early primary care provider follow-up and readmission after high-risk surgery. / Brooke, Benjamin S.; Stone, David H.; Cronenwett, Jack L.; Nolan, Brian; De Martino, Randall R; MacKenzie, Todd A.; Goodman, David C.; Goodney, Philip P.

In: JAMA Surgery, Vol. 149, No. 8, 2014, p. 821-828.

Research output: Contribution to journalArticle

Brooke, BS, Stone, DH, Cronenwett, JL, Nolan, B, De Martino, RR, MacKenzie, TA, Goodman, DC & Goodney, PP 2014, 'Early primary care provider follow-up and readmission after high-risk surgery', JAMA Surgery, vol. 149, no. 8, pp. 821-828. https://doi.org/10.1001/jamasurg.2014.157
Brooke, Benjamin S. ; Stone, David H. ; Cronenwett, Jack L. ; Nolan, Brian ; De Martino, Randall R ; MacKenzie, Todd A. ; Goodman, David C. ; Goodney, Philip P. / Early primary care provider follow-up and readmission after high-risk surgery. In: JAMA Surgery. 2014 ; Vol. 149, No. 8. pp. 821-828.
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abstract = "IMPORTANCE Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. OBJECTIVE To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively. DESIGN, SETTING, AND PARTICIPANTS In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use.We stratified our analysis by the presence of complications during the surgical (index) admission. MAIN OUTCOMES AND MEASURES Thirty-day readmission rate. RESULTS Overall, 2619 patients (20.6{\%}) undergoing open TAA repair and 4927 patients (9.3{\%}) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6{\%}) undergoing open TAA repair and 4528 patients (8.6{\%}) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0{\%}(without follow-up) to 20.4{\%}(with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4{\%}with follow-up vs 21.9{\%}without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18{\%}lower likelihood of 30-day readmission (odds ratio, 0.82; 95{\%}CI, 0.71-0.96; P = .02), whereas no significant difference was found among patients after VHR. CONCLUSIONS AND RELEVANCE Follow-up with a PCP after high-risk surgery (eg, open TAA repair), especially among patients with complications, is associated with a lower risk of hospital readmission. Patients undergoing lower-risk surgery (eg, VHR) do not receive the same benefit from early PCP follow-up. Identifying high-risk surgical patients who will benefit from PCP integration during care transitions may offer a low-cost solution toward limiting readmissions.",
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AU - MacKenzie, Todd A.

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N2 - IMPORTANCE Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. OBJECTIVE To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively. DESIGN, SETTING, AND PARTICIPANTS In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use.We stratified our analysis by the presence of complications during the surgical (index) admission. MAIN OUTCOMES AND MEASURES Thirty-day readmission rate. RESULTS Overall, 2619 patients (20.6%) undergoing open TAA repair and 4927 patients (9.3%) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6%) undergoing open TAA repair and 4528 patients (8.6%) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0%(without follow-up) to 20.4%(with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4%with follow-up vs 21.9%without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18%lower likelihood of 30-day readmission (odds ratio, 0.82; 95%CI, 0.71-0.96; P = .02), whereas no significant difference was found among patients after VHR. CONCLUSIONS AND RELEVANCE Follow-up with a PCP after high-risk surgery (eg, open TAA repair), especially among patients with complications, is associated with a lower risk of hospital readmission. Patients undergoing lower-risk surgery (eg, VHR) do not receive the same benefit from early PCP follow-up. Identifying high-risk surgical patients who will benefit from PCP integration during care transitions may offer a low-cost solution toward limiting readmissions.

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