Related Experiment Video
Updated: Jun 23, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Early primary care provider follow-up and readmission after high-risk surgery
Benjamin S Brooke1, David H Stone2, Jack L Cronenwett2
1Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City.
Insights
Primary care provider follow-up after high-risk surgery, like open thoracic aortic aneurysm repair, significantly lowers readmission rates, especially for patients with complications. This benefit was not observed for lower-risk ventral hernia repair patients.
Area of Science:
- Health Services Research
- Surgical Outcomes
- Patient Care Coordination
Background:
- Routine follow-up with primary care providers (PCPs) post-major surgery is recommended but lacks strong evidence of improved outcomes.
- The benefit of PCP follow-up during care transitions after surgery is not well-defined.
Purpose of the Study:
- To determine if PCP follow-up is associated with reduced 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR).
- To assess the impact of PCP follow-up on readmissions based on surgical risk and patient complications.
Main Methods:
- A cohort study of Medicare beneficiaries undergoing open TAA repair (n=12,679) and VHR (n=52,807) from 2003-2010.
- Comparison of 30-day readmission rates between patients with and without PCP follow-up within 30 days of discharge.
- Analysis stratified by surgical procedure (high-risk TAA vs. low-risk VHR) and presence of perioperative complications.
Main Results:
- PCP follow-up significantly reduced 30-day readmissions for open TAA repair patients with complications (35.0% to 20.4%).
- No significant reduction in readmissions was observed for uncomplicated TAA repair patients or any VHR patients (with or without complications).
- Higher regional primary care use was associated with lower readmission rates for TAA repair but not VHR.
Conclusions:
- PCP follow-up is associated with lower hospital readmission risk after high-risk surgery, particularly for patients experiencing complications.
- Early PCP follow-up does not appear to benefit patients undergoing lower-risk surgery like VHR.
- Integrating PCPs into care transitions for high-risk surgical patients may reduce readmissions.
Importance:
Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes.
Objective:
To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively.
Design, Setting, And Participants:
In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use. We stratified our analysis by the presence of complications during the surgical (index) admission.
Main Outcomes And Measures:
Thirty-day readmission rate.
Results:
Overall, 2619 patients (20.6%) undergoing open TAA repair and 4927 patients (9.3%) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6%) undergoing open TAA repair and 4528 patients (8.6%) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0% (without follow-up) to 20.4% (with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4% with follow-up vs 21.9% without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18% lower likelihood of 30-day readmission (odds ratio, 0.82; 95% CI, 0.71-0.96; P = .02), whereas no significant difference was found among patients after VHR.
Conclusions And Relevance:
Follow-up with a PCP after high-risk surgery (eg, open TAA repair), especially among patients with complications, is associated with a lower risk of hospital readmission. Patients undergoing lower-risk surgery (eg, VHR) do not receive the same benefit from early PCP follow-up. Identifying high-risk surgical patients who will benefit from PCP integration during care transitions may offer a low-cost solution toward limiting readmissions.
Related Concept Videos
01:26Traditional Level Of Health Care System
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...
01:11Secondary Healthcare System
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:16Kidney Transplant III: Nursing Management