Outcomes/Effectiveness Research

Consultations on major surgeries bring higher costs and longer stays but not care improvements

Just 1 in 10 major surgeries involves the services of a medical consultant in the days before and after an operation. Further, these discussions do not result in higher quality care for the patient, a new study finds. Andrew D. Auerbach, M.D., M.P.H., undertook the study to understand the effect of consultations the day before, the day of, or the day after a major surgery in terms of costs and length of hospital stay.

Dr. Auerbach, from the Department of Medicine at the University of California, San Francisco, and his colleagues examined records for patients seen at the University's medical center from May 1, 2004 to May 31, 2006. Of the 1,282 patients studied, less than 10 percent underwent a surgical consultation. Those who received consultations had diabetes (29 percent), vascular disease (35 percent), or kidney failure (24 percent), and tended to have severe systemic, life-threatening diseases.

Costs almost doubled for patients who received consultations ($155,020) compared with those who did not ($74,237), and their median hospital stay was longer (10 days vs. 6 days). The authors suggest costs may be higher when consultants are brought in because they may request additional lab tests or procedures. Patients seen by generalists stayed in the hospital as long as those seen by consulting specialists but were more likely to pay less and receive therapies to prevent venous thromboembolism (a blocked blood vessel that can develop after an operation).

Care quality may not have improved when consultants were included for a couple of reasons. One, medical consultants may have been respecting their colleague's turf and opted to answer just the question they were asked. Two, the consultant's advice may not have been heeded. This scenario presents an opportunity to improve the consultation process, the authors suggest. This study was funded in part by the Agency for Healthcare Research and Quality (HS11416).

See "Opportunity missed: Medical consultation, resource use, and quality of care of patients undergoing major surgery," by Dr. Auerbach, Mladen A. Rasic, M.D., Neil Sehgal, M.P.H., and others in the November 26, 2007 Archives of Internal Medicine 167(21), pp. 2338-44.

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