Daily Dose: Primary Care Follow-Up and 30-Day Readmission After Emergency Surgery

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On September 29, 2023, we reported on findings from a study published in JAMA Surgery that examined the association between primary care physician (PCP) follow-up and 30-day readmission rates after hospital discharge for an emergency general surgery (EGS) condition.

The study

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

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 index admission.

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.

Findings

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).

Authors' comment

"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."

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