Patients who underwent thoracic aortic aneurysm surgery and experienced complications benefited most from early primary care provider (PCP) visits, according to a study published online June 25 in JAMA: Surgery. Patients who saw their PCP soon after a complicated surgery had a 47 percent decrease in the likelihood of 30-day readmissions compared with those who didn’t.
Researchers compared Medicare data on 52,807 ventral hernia repairs and 12,679 open thoracic aortic aneurysm surgeries to determine if visiting a PCP early post-operation assisted in reducing 30-day readmission rates. Thoracic aortic aneurysm surgery carries a high risk of readmission while ventral hernia repairs are considered low risk.
Patients who had early follow-up care following all thoracic aortic aneurysm surgeries were far less likely to be readmitted in 30 days: 19 percent of those who visited their doctor were readmitted in 30 days as opposed to 28 percent who did not. When looking at 30-day readmission rates of thoracic aortic aneurysm patients who had experienced complications post-surgery, 20.4 percent had seen a PCP, however 35 percent had not.
The team led by Benjamin S. Brooke, MD, PhD, of the University Of Utah School Of Medicine’s Division of Vascular Surgery in Salt Lake City, noted a large difference in 30-day readmission rates for thoracic aortic aneurysm surgeries, but not all of the data they assessed showed the same magnitude of change. Thirty-day readmission rates for ventral hernia repair were low from the start. Only 9.3 percent of ventral hernia repair patients were readmitted as opposed to 22.1 percent of open thoracic aortic aneurysm surgery. For ventral hernia patients, no benefit was seen in early provider follow-up.
Little difference was also noted in the number of patients who experienced an uncomplicated post-operative course following thoracic aortic aneurysm surgery, 19.4 percent with vs. 21.9 percent without follow-up.
Brooke et al acknowledged the importance of provider care early following post-operative discharge, particularly for managing potential complications and reducing 30-day readmissions. They suggested developing metrics to determine which patients would be at most risk. Targeting and emphasizing the importance of early primary care provider visits to those patients would provide the greatest effect in reducing rates overall while avoiding burden on patients and providers.