PCP follow-up after surgery associated with lower readmission rates
Medicare beneficiaries hospitalized for an emergency general surgery condition had a 67% lower adjusted risk for readmission if they had a follow-up appointment with a primary care physician (PCP) within 30 days of discharge.
Timely follow-up with a primary care physician may reduce risk for hospital readmission after treatment for an emergency general surgery condition, according to a recent study.
Researchers used CMS data to perform a cohort study of patients hospitalized with an emergency general surgery condition managed with or without surgery between Sept. 1, 2016, and Nov. 30, 2018. Patients were eligible for the study if they were ages 66 years or older, were enrolled in Medicare fee-for-service, were admitted through the ED with a primary diagnosis of an emergency general surgery condition (general abdominal, colorectal, hepatopancreatobiliary, intestinal obstruction, hernia, or upper GI), and had a general surgery consult. The study's primary outcome was readmission within 30 days after discharge, and an inverse probability-weighted regression model was used to estimate the risk-adjusted association between follow-up with a primary care physician and 30-day readmissions. The results were published Sept. 27 by JAMA Surgery.
Overall, 345,360 Medicare beneficiaries were included in the study. The mean age was 74.4 years, and 54.4% were women. Fewer than half of the patients (45.4%) had a follow-up primary care visit, 31.4% received surgical treatment during their index admission, and 68.6% received nonsurgical treatment. The readmission rate within 30 days of the index admission was 17.5%. After risk adjustment and propensity weighting, the adjusted odds ratio (OR) for readmission in patients with versus without primary care follow-up was 0.33 (95% CI, 0.31 to 0.36). Readmissions were lower with follow-up in both patients who were treated surgically during their index admission (adjusted OR, 0.21; 95% CI, 0.18 to 0.25) and those treated nonsurgically (adjusted OR, 0.36; 95% CI, 0.34 to 0.39). Patients were most frequently readmitted due to infection, chronic kidney disease, heart failure, and acute kidney failure.
The authors noted that their findings could have been affected by unmeasured confounders and that they were not able to evaluate telemedicine follow-up, among other limitations. They concluded that follow-up with a primary care physician within 30 days after discharge was associated with decreased readmission rates among patients hospitalized for an emergency general surgery condition. “Surgical- and nonsurgical-related conditions accounted for a large proportion of readmissions in this study. Whether or not a surgical visit was received did not change the association between PCP [primary care physician] follow-up and 30-day readmission,” the authors wrote. “Together, these findings suggest that PCP follow-up within 30 days after discharge is associated with lower readmission rates for patients with [emergency general surgery] conditions.”
An accompanying editorial pointed out that many medications are adjusted perioperatively, including beta-blockers, deep venous thrombosis prophylaxis, and antibiotics, and said that monitoring new medications while tapering existing ones is best done by the patient's primary care physician. The editorialist, a surgeon, noted that remote monitoring will play a larger part in such management in the future. “It is highly likely that perioperative PCP specialists will monitor the data centers for sensor and patient-reported data and evolve to become our partnered remote medicine colleagues to deliver superb care for surgical patients in the 21st century,” he concluded.