Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients

Abstract

Objectives Among a national cohort of surgical patients, the authors analyzed the association between medical follow-up during the first postsurgical year and survival during the second postsurgical year. Design Retrospective cohort study. Setting US Veterans Hospitals. Participants The study included adults who received surgical care in any Veterans Health Administration facility from 2006 to 2011 who were discharged within 10 days of surgery and who survived for at least 1 year postoperatively. Interventions None. Measurements and Main Results The association between the receipt of nonsurgical ambulatory medical care during the first postoperative year and the hazard of death during postsurgical year 2 was measured. Among 236,200 veterans, 93.2% received a nonsurgical medical follow-up visit in postsurgical year 1; of those, 5.1% died during postsurgical year 2. This compares with 9.4% year-2 mortality among patients lacking year-1 medical follow-up (p < 0.0001). After adjustment for confounders, medical follow-up in postoperative year 1 again was associated with a significantly lower hazard of death in postoperative year 2 (hazard ratio 0.71; 95% confidence interval 0.66–0.78). Sensitivity analyses examining patient subgroups stratified by procedural specialty demonstrated comparable findings. The results were robust under a variety of simulated scenarios of unmeasured confounding. Conclusions Within a national cohort of US veterans who presented for surgery, those who received nonsurgical ambulatory follow-up during the first postoperative year demonstrated lower all-cause mortality in the subsequent postoperative year than those who did not receive the same type of follow-up care. Interventions focused on postoperative care coordination of outpatient medical follow-up may have the potential to improve long-term postoperative survival.

Encuesta Semi Sobre La Organización Y Actividad en Interconsultas Y Asistencia Compartida

“…Sin embargo, el número de hospitales en los que se hace algún tipo de consulta pre o postoperatoria es similar al del único estudio disponible 4 , sin avances en este sentido. Este aspecto es fundamental, porque tanto las consultas pre 5,6 como las postquirúrgicas 7 hechas por internistas han demostrado la mejora de resultados en salud. Además, solo en la mitad de los centros la dirección hace algún tipo de seguimiento de esta actividad, lo que demuestra un escaso interés institucional por la misma en la actualidad, si bien la gran mayoría de las unidades sí registran, aunque sea de forma elemental, Este estudio tiene limitaciones.…”

The effect of race on postsurgical ambulatory medical follow-up among United States Veterans

“…[18] The resulting cohort is being used in several studies examining the relationship between perioperative assessments and postoperative outcomes. [10, 18]…”

“…[18] Briefly, patients were identified by their unique Patient Integration Control Number (PatientICN) assigned by the VHA Master Veteran Index. Demographic information, surgical specialty, American Society of Anesthesiologists Physical Status score (ASA Physical Status score),[21] and ICD-9-CM inpatient diagnostic codes dating from January 2000 to the index surgery date were extracted from the VHA Corporate Data Warehouse for inclusion in this analysis.…”

“…As has been described previously, a Stop Code for any of the following clinics was considered positive for the exposure of interest: primary care, cardiology, pulmonology, endocrinology, diabetes, hypertension, women’s, infectious disease, and geriatric primary care. [18] This outpatient clinic list was based on the NEXUS clinic group as defined by the VHA External Peer Review Program, with the addition of infectious disease clinics. NEXUS clinic visits are used to determine which Veterans are receiving Primary Care across the VHA system.…”

Rebranding the Perioperative Surgical Home: Lessons From the Duke Experience

“…With even greater potential impact, they have proposed a perioperative preventive health maintenance clinic. This clinic relates to work that I and others have been advocating [12][13][14] whereby the perioperative team screens for modifiable preventive health risk factors such as missing vaccinations, poor blood pressure control, and hyperlipidemia among surgical patients.…”