Quelle optimisation possible de la prise en charge médicale des patients, en post-opératoire, par le médecin généraliste dans un service de Neurochirurgie ?

Abstract : Importance: The postoperative patient care in neurosurgery has grown in recent decades due to an aging population and chronic diseases. In some countries, the co-management responds to this demand. Hospitalists are assuming an increasing role in the postoperative care of surgical patients but the impact of the model on postoperative outcomes is not clearly assessed. Objective: Which role can play the hospitalist in optimizing the medical postoperative patient care in a neurosurgery department? Design: Prospective and comparative six-month cohort study Setting: Academic medical center (La Timone, Marseille, France), adult neurosurgery department of Professor Dufour, from September 1, 2017 to February 28, 2018 Participants: 234 patients divided into 2 branches over 2 months in 2 different units of the department (Unit A or Unit B), according to the allocation of the hospitalist (in September within unit A, and in October within unit B). Measurements: Inpatient postoperative complications and complications in the mid-term (re-admissions), length of stay, medical consultations. Intervention: A co-management hospitalist-neurosurgeon team in postoperative care compared with standard postoperative care by neurosurgeons with medical consultation. Material and methods: All cranial or spine cases operated or not in the framework of an urgent or regulated surgery were included and followed over a period of 1 to 4 months. Results: The patients were comparable in number, age, gender, reasons for hospitalization, means of admission and scales of multimorbidity (Asa and Charlson). The average length of stay was statistically reduced by 10.13 days (standard deviation 7.76, CI 8.77 to 11.49) to 7.07 days (standard deviation 3.94, CI 6.31 to 7.82, p = 0.0087), without and with the presence of a hospitalist. The medical consultation rate was also statistically reduced. The one-third decrease in medical complications, was not statistically significant. However, there was a significant association between age, multimorbidity and the occurrence of inpatient complications. Conclusion: The co-management hospitalist-neurosurgeon reduced medical postoperative consultations and the length of stay with no statistically difference in complication rates. Additional research on the job description as well as the economic impact of this hospitalist model is warranted.
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Delphine Rousseau. Quelle optimisation possible de la prise en charge médicale des patients, en post-opératoire, par le médecin généraliste dans un service de Neurochirurgie ?. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01958529⟩

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