Key result
Supervised student-led follow-up fails to reduce 1-year unplanned readmissions versus standard care after cardiac surgery.
Why the study?
Readmission rates following open cardiac surgery are high, affecting patients and the cost of care.
Does early additional follow-up by supervised medical students reduce unplanned cardiac-related readmissions in patients undergoing open cardiac surgery?
Cohort (n=419)
Open-label
Computer randomization if eligible patients exceeded logistic capacity
No
Does early additional follow-up by supervised medical students reduce unplanned cardiac-related readmissions in patients undergoing open cardiac surgery?
Absolute Event Rate: 32% vs 30%
p-value: p=0.71
Supervised student-led early follow-up after open cardiac surgery did not reduce 1-year readmission rates but facilitated earlier detection and non-emergent treatment of complications.
Student-led follow-up should not yet change post-cardiac surgery pathways; leaves open benefits for earlier complication detection in prospective trials.
Objectives. Readmission rates following open cardiac surgery are high, affecting patients and the cost of care. This study aimed to investigate the effect of early additional follow-up after open cardiac surgery when 5th-year medical students conducted follow-ups under the supervision of physicians. The primary endpoint was unplanned cardiac-related readmissions within one year. The secondary outcomes were the detection of impending complications and health-related quality of life (HRQOL). Methods. Patients undergoing open cardiac surgery were prospectively included. For intervention, additional follow-up visits, including point-of-care ultrasound, were conducted by supervised 5th-year medical students on postoperative days 3, 14 and 25. Unplanned cardiac-related readmissions, including emergency department visits, were registered within the first year of surgery. Danish National Health Survey 2010 questionnaire was used for HRQOL. In standard follow-up, all patients were seen 4-6 weeks postoperative. Results. For data analysis, 100 of 124 patients in the intervention group and 319 of 335 patients in the control group were included. The 1-year unplanned readmission rates did not differ; 32% and 30% in the intervention and control groups, respectively (p = 0.71). After discharge, 1% of patients underwent pericardiocentesis. The additional follow-up initiated scheduled drainage, contrary to more unscheduled/acute drainages in the control group. Pleurocentesis was more common in the intervention group (17% (n = 17) vs 8% (n = 25), p = 0.01) and performed earlier. There was no difference between groups on HRQOL. Conclusion. Supervised student-led follow-up of newly cardiac-operated patients did not alter readmission rates or HRQOL but may detect complications earlier and initiate non-emergent treatment of complications.
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Ilkjær et al. (2023) conducted a cohort in Open cardiac surgery (n=419). Additional early follow-up by supervised medical students vs. Standard follow-up (4-6 weeks postoperative) was evaluated on Unplanned cardiac-related readmissions within one year (p=0.71). Supervised student-led follow-up of newly cardiac-operated patients did not significantly alter the 1-year unplanned readmission rate (32% vs 30%, p=0.71) compared to standard care.
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