Impact of physician co‐management on duration of hospitalisation among surgical patients: a retrospective pre–post analysis at a tertiary centre

BACKGROUND: Physician co-management (PCM) models are emerging as an effective strategy to improve outcomes for surgical patients with multimorbidity. AIMS: To evaluate whether PCM was associated with reduced hospital length of stay (LOS) in a mixed surgical cohort. METHODS: We conducted a single-centre quasi-experimental pre-post study. The intervention group (March to August 2024, after PCM) received embedded PCM with daily multidisciplinary input. The control group (March to July 2023, before PCM) received reactive physician consultations. Adults (≥18 years) admitted under acute surgical, upper gastrointestinal, hepatobiliary or vascular surgery 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, readmissions and days alive at home (DAH). RESULTS: Of 600 patients (300 per group), age (mean 67.5 vs 68.0 years) and Charlson Comorbidity Index (median 4 vs 4) were similar. Mean LOS was reduced in the post-PCM group (11.3 vs 13.1 days; mean difference 1.79 days (95% confidence interval (CI) 0.18-3.39)). After multivariable adjustment, PCM was associated with a 2.8-day reduction in LOS (95% CI -5.3 to -0.3; P = 0.027). Post-PCM patients had fewer respiratory complications (6.7% vs 11.3%; P = 0.046) and lower unplanned readmissions at 30 days (18.0% vs 28.7%; P = 0.002) and 90 days (25.7% vs 35.0%; P = 0.012) when compared to the pre-PCM group. Mortality and DAH were similar between the two groups. CONCLUSION: PCM was associated with reduced LOS and readmissions in surgical inpatients, supporting its role in improving outcomes.