Key result
A preoperative optimization visit with a nonsurgical clinician reduced the adjusted odds of a 30-day postoperative complication by 31% in patients with major comorbidities undergoing elective colectomy.
Why the study?
Does a preoperative optimization visit by a nonsurgical clinician reduce 30-day postoperative complications in patients with major comorbidities undergoing elective colectomy?
Observational (n=6,037)
Yes
Does a preoperative optimization visit by a nonsurgical clinician reduce 30-day postoperative complications in patients with major comorbidities undergoing elective colectomy?
Odds Ratio: 0.69
Absolute Event Rate: 29.7% vs 34.6%
p-value: p=<0.001
Preoperative optimization visits with nonsurgical clinicians for patients with major comorbidities undergoing elective colectomy are associated with a significant reduction in 30-day postoperative complications.
May support preoperative optimization visits in high-risk colectomy patients; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVE: The purpose of this study was to evaluate the impact of optimization of preoperative comorbidities by nonsurgical clinicians on short-term postoperative outcomes. SUMMARY BACKGROUND DATA: Preoperative comorbidities can have substantial effects on operative risk and outcomes. The modifiability of these comorbidity-associated surgical risks remains poorly understood. METHODS: We identified patients with a major comorbidity (eg, diabetes, heart failure) undergoing an elective colectomy in a multipayer national administrative database (2010-2014). Patients were included if they could be matched to a preoperative surgical clinic visit within 90 days of an operative intervention by the same surgeon. The explanatory variable of interest ("preoperative optimization") was defined by whether the patient was seen by an appropriate nonsurgical clinician between surgical consultation and subsequent surgery. We assessed the impact of an optimization visit on postoperative complications with use of propensity score matching and multilevel, multivariable logistic regression. RESULTS: We identified 4531 colectomy patients with a major potentially modifiable comorbidity (propensity weighted and matched effective sample size: 6037). After matching, the group without an optimization visit had a higher rate of complications (34.6% versus 29.7%, P = 0.001). An optimization visit conferred a 31% reduction in the odds of a complication (P < 0.001) in an adjusted analysis. Median preoperative costs increased by $684 (P < 0.001) in the optimized group, and a complication increased total costs of care by $14,724 (P < 0.001). CONCLUSIONS AND RELEVANCE: We demonstrated an association between use of nonsurgical clinician visits by comorbid patients prior to surgery and a significantly lower rate of complications. These findings support the prospective study of preoperative optimization as a potential mechanism for improving postoperative outcomes.
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Leeds et al. (2018) conducted an observational in Major modifiable comorbidities in patients undergoing elective colectomy (n=6,037). Preoperative optimization visit by a nonsurgical clinician vs. No preoperative optimization visit was evaluated on Postoperative complications within 30 days (31% reduction in odds, p=<0.001). A preoperative optimization visit with a nonsurgical clinician reduced the adjusted odds of a 30-day postoperative complication by 31% in patients with major comorbidities undergoing elective colectomy.
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