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- Title
Primary Care Physician Follow-Up and 30-Day Readmission After Emergency General Surgery Admissions.
- Authors
Moneme, Adora N.; Wirtalla, Christopher J.; Roberts, Sanford E.; Keele, Luke J.; Kelz, Rachel R.
- Abstract
This cohort study examines whether follow-up with a primary care physician within 30 days after hospital discharge for an emergency general surgery condition is associated with risk of readmission. Key Points: Question: Is there an association between primary care follow-up and 30-day readmission after hospitalization for an emergency general surgery (EGS) condition? Findings: In this cohort study of 345 360 Medicare beneficiaries who were admitted for an EGS condition from 2016 to 2018, primary care follow-up within 30 days after 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. Meaning: Results of this study suggest that primary care follow-up may reduce risk of readmission after an admission for an EGS condition in both operatively and nonoperatively treated patients. Importance: The benefit of primary care physician (PCP) follow-up as a potential means to reduce readmissions in hospitalized patients has been found in other medical conditions and among patients receiving high-risk surgery. However, little is known about the implications of PCP follow-up for patients with an emergency general surgery (EGS) condition. Objective: To evaluate the association between PCP follow-up and 30-day readmission rates after hospital discharge for an EGS condition. Design, Setting, and Participants: This cohort study used data from the Centers for Medicare & Medicaid Services Master Beneficiary Summary File, Inpatient, Carrier (Part B), and Durable Medical Equipment files for beneficiaries aged 66 years or older who were hospitalized with an EGS condition that was managed operatively or nonoperatively between September 1, 2016, and November 30, 2018. Eligible patients were enrolled in Medicare fee-for-service, admitted through the emergency department with a primary diagnosis of an EGS condition, and received a general surgery consultation during the admission. Data were analyzed between July 11, 2022, and June 5, 2023. Exposure: Follow-up with a PCP within 30 days after hospital discharge for the index admission. Main Outcomes and Measures: The primary outcome was readmission within 30 days after discharge for the index admission. An inverse probability weighted regression model was used to estimate the risk-adjusted association of PCP follow-up with 30-day readmission. The secondary outcome was readmission within 30 days after discharge stratified by treatment type (operative vs nonoperative treatment) during their index admission. Results: The study included 345 360 Medicare beneficiaries (mean [SD] age, 74.4 [12.0] years; 187 804 females [54.4%]) hospitalized with an EGS condition. Of these, 156 820 patients (45.4%) had a follow-up PCP visit, 108 544 (31.4%) received operative treatment during their index admission, and 236 816 (68.6%) received nonoperative treatment. Overall, 58 253 of 332 874 patients (17.5%) were readmitted within 30 days after discharge for the index admission. After risk adjustment and propensity weighting, patients who had PCP follow-up had 67% lower odds of readmission (adjusted odds ratio [AOR], 0.33; 95% CI, 0.31-0.36) compared with patients without PCP follow-up. After stratifying by treatment type, patients who were treated operatively during their index admission and had subsequent PCP follow-up within 30 days after discharge had 79% reduced 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). 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. Conclusions and Relevance: In this cohort study, follow-up with a PCP within 30 days after discharge for an EGS condition was associated with a significant reduction in the adjusted odds of 30-day readmission. This association was similar for patients who received operative care or nonoperative care during their index admission. In patients aged 66 years or older with an EGS condition, primary care coordination after discharge may be an important tool to reduce readmissions.
- Publication
JAMA Surgery, 2023, Vol 158, Issue 12, p1293
- ISSN
2168-6254
- Publication type
Article
- DOI
10.1001/jamasurg.2023.4534