Early Physician Follow-Up and Out-of-Hospital Outcomes After Cerebral Aneurysm Treatment in Elderly Patients

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• 作者：Kimon Bekelis¹ ; ⁴ ; ^{kbekelis@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Dan Gottlieb⁴ ; Yin Su⁴ ; Nicos Labropoulos⁵ ; Stavropoula Tjoumakaris⁶ ; Pascal Jabbour⁶ ; Todd A. MacKenzie² ; ³ ; ⁷
• 关键词：Cerebral aneurysm ; Follow up ; Medicare ; Postacute care ; Subarachnoid hemorrhage
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：95
• 期：Complete
• 页码：542-547.e1
• 全文大小：495 K

文摘

The impact of early physician follow-up on out-of-hospital outcomes after cerebral aneurysm treatment has not been studied previously. We investigated the association of early physician follow-up (within 30 days of discharge) with mortality and readmissions for elderly patients undergoing treatment for cerebral aneurysms.

Methods

We performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent treatment for cerebral aneurysms from 2007 to 2012. To control for confounding, we used propensity score conditioning and inverse probability weighting, with mixed effects to account for clustering at the Hospital Referral Region level.

Results

Of 8703 patients presenting with unruptured aneurysms, 5673 (65.2%) had early physician follow-up, and 3030 (34.8%) did not. Of 3211 patients with subarachnoid hemorrhage, 1504 (46.8%) had early physician follow-up, and 1707 (53.2%) did not. Propensity score−adjusted analysis demonstrated that patients with unruptured aneurysms who visited a physician within 30 days of discharge had lower 3-month mortality (odds ratio [OR] 0.52; 95% confidence interval [95% CI] 0.36–0.74) but a greater rate of 90-day readmissions (OR 1.14; 95% CI 1.03–1.28). Similarly, early follow-up was associated with lower 3-month mortality (OR, 0.33; 95% CI, 0.24–0.46), and a greater rate of 90-day readmissions (OR 1.79; 95% CI 1.02–3.14) for patients presenting with subarachnoid hemorrhage.

Conclusions

In a cohort of Medicare patients undergoing treatment for cerebral aneurysms, we identified an association of early physician follow-up with decreased short-term post-discharge mortality, but increased 90-day readmissions. More studies on the impact of strengthening the post-discharge network on the outcomes of this population are warranted.