Comanagement of surgical patients between neurosurgeons and internal-medicine clinicians: observational cohort study.

Abstract

The rising prevalence of chronic diseases have contributed to a population with high complexity of care. There has been an increasing need for a new organizational model based on the interaction in the same department between the specialist skills of surgical and medical disciplines. This study aims to describe the implementation of a hospitalist co-management program in a Neurosurgery Department (ND) and its impact on the incidence of medical complications, 30 days readmission rate for medical causes, number of transfers to Intensive Care Units (ICU)/Neurosurgical Intensive Care Unit (NICU) or to medical wards (MW), length-of stay (LOS), mortality and satisfaction of health workers. We conducted an observational study comparing changes before and after the Internal medicine-Neurosurgical Comanagement (INC) intervention. We conducted a retrospective evaluation of patients enrolled before the INC intervention and a prospective evaluation of those enrolled after the INC intervention was implemented. We defined the pre-INC intervention group as 380 patients admitted to the ND for neurosurgical disease between January 2022 and April 2022 and the post-INC intervention group as 367 patients admitted to the ND between January 2023 and April 2023. INC intervention was associated with a significant decrease in medical complications during the hospital stay (OR 0.52; 95% CI; 0.39-0.70, p < 0.001), 30 days in-hospital readmission for medical reasons (OR 0.95; 95% CI 0.93-0.97, p < 0.001) and numbers of transfers to ICU/NICU (OR 0.31; 95% CI; 0.17-0.55, p < 0.001) or MW (OR 0.51; 95% CI 0.33-0.77, p = 0.002). During the INC intervention period, we observed a high satisfaction rate in health workers, evaluated by standardized questionnaire. In our study, LOS, in-hospital mortality and 30-day mortality were not significantly associated with INC. Hospitalist co-management in Neurosurgical Departments was associated with a reduced incidence of medical complications, 30-days in-hospital readmission and numbers of transfers to ICU/NICU or MW with a high satisfaction rate among healthcare workers, but without a significant decrease in LOS and mortality rate.