Background: The ageing population and rising burden of multimorbidity among surgical patients increase the risk of complications, prolonged hospitalisation, and readmissions. Proactive physician co-management (PCM) models of care have emerged to improve outcomes, yet evidence in heterogeneous surgical populations remains limited.
Aims: To evaluate the impact of PCM on hospital length of stay (LOS).
Methods: Single-centre quasi-experimental pre–post study comparing a historical control cohort (March–July 2023; reactive physician consultation) with an intervention cohort (March–August 2024) managed under a physician-led co-management model with daily multidisciplinary involvement. Consecutive adults (≥18 years) admitted under acute surgical, upper gastrointestinal, hepatobiliary, or vascular surgery units were included. Patients hospitalised for <2 days or transferred to or from another institution were excluded. The primary outcome was LOS; secondary outcomes included complications, mortality, unplanned readmissions, and days alive at home (DAH).
Results: Six hundred patients were included (pre-PCM n=300; post-PCM n=300). Baseline characteristics were similar (mean age 68.0 vs 67.5 years; Charlson Comorbidity Index median 4 vs 4). Mean LOS was shorter post-PCM (11.3 vs 13.1 days; mean difference 1.8 days, 95% CI 0.2–3.4). After multivariable adjustment, PCM was associated with a 2.8-day reduction in LOS (95% CI −5.3 to −0.3; p=0.027). Respiratory complications (7% vs 11%; p=0.046) and unplanned readmissions at 30 days (18% vs 29%; p=0.003) and 90 days (26% vs 35%; p=0.020) were lower post-PCM. Mortality was similar (2% vs 2%), and DAH30 and DAH90 did not differ.
Conclusions: PCM was associated with shorter hospital stay and fewer unplanned readmissions.