Primary Care Follow-Up After Emergency Surgery May Help Prevent Readmissions, Improve Patient Outcomes

Primary care follow-up may decrease risk of hospital readmission after admission for an emergency general surgery (EGS) condition, whether the condition is managed operatively or nonoperatively, according to a new study.

In a cohort study of over 345 000 Medicare beneficiaries admitted for an EGS condition, researchers found that primary care follow-up within 30 days of discharge was associated with a 67% adjusted reduced risk of 30-day readmission.

“A similar association was seen when data were stratified by receipt of operative vs nonoperative treatment during the index admission,” wrote corresponding author Rachel Kelz, MD, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and colleagues in the study, published September 27, 2023, in JAMA Surgery.

Citing a lack of research on the use of primary care follow-up for patients undergoing EGS, Kelz and coauthors aimed to fill the “knowledge gap,” examining the association between primary care physician (PCP) follow-up and 30-day readmission rates following hospital discharge among patients managed either operatively or nonoperatively. The investigators believe their study is the first to describe the association.

“There is growing evidence that nonoperative treatment is favorable for several surgical diseases in the acute setting, and there is a pattern of increased use of nonoperative treatment,” wrote authors. “Therefore, it is critical to understand the implications of postdischarge interventions for both operatively and nonoperatively treated patients.”

Researchers used Medicare claims data to conduct the current study of beneficiaries aged ≥66 years who were hospitalized with an EGS condition managed either surgically or nonsurgically between September 1, 2016, and November 30, 2018, according to the study.

The primary outcome was hospital readmission within 30 days after discharge, and the secondary outcome was readmission within 30 days after discharge “stratified by treatment type (operative vs nonoperative treatment) during their index admission,” wrote authors.

FINDINGS

The cohort consisted of 345 360 Medicare beneficiaries (mean age, 74 years; 54.4% women) hospitalized with 1 of 6 EGS conditions (ie, general abdominal, colorectal, hepatopancreatobiliary, intestinal obstruction, hernia, and upper gastrointestinal). Among the cohort:

• 45.4% (n=156 820) had a follow-up PCP visit,
• 31.4% (n=108 544) received operative treatment, and
• 68.6% (n=236 816) received nonoperative treatment.

According to Kelz and colleagues, overall, 17.5% (58 253 of 332 874 patients) were readmitted to the hospital within 30 days following discharge. After risk adjustment and propensity weighting, authors noted that patients who had received PCP follow-up had 67% lower odds of readmission (adjusted odds ratio [AOR], 0.33, 95% CI 0.31-0.36) compared with participants without PCP follow-up.

Moreover, after investigators stratified by treatment type, they found that participants who received operative treatment and had subsequent PCP follow-up within 30 days of discharge had 79% lower odds of readmission (AOR, 0.21, 95% CI 0.18-0.25). A similar association was seen among patients who were treated nonoperatively (AOR, 0.36, 95% CI 0.34-0.39), noted Kelz and coauthors.

“Infectious conditions, heart failure, acute kidney failure, and chronic kidney disease were among the most frequent diagnoses prompting readmission overall and among operative and nonoperative treatment groups,” wrote authors.

“In patients aged 66 years or older with an EGS condition, primary care coordination after discharge may be an important tool to reduce readmissions,” concluded Kelz et al.

Source: Moneme AN, Wirtalla CJ, Roberts SE, Keele LJ, Kelz RR. Primary care physician follow-up and 30-day readmission after emergency general surgery admissions. JAMA Surg. Published online September 27, 2023. doi:10.1001/jamasurg.2023.4534