Influence of internal medicine perioperative consult team on vascular surgical patients

Abstract

Background: In 2015, an Internal Medicine Perioperative Consult Team (IMPCT) was created in our hospital. We sought to determine whether they improve perioperative care without unnecessarily delaying surgery. Objectives:To evaluate the IMPCT service on vascular surgery patient outcomes and course in hospital.Methods: Using a prospectively maintained database, we compared vascular surgery patients who received a preoperative IMPCT consult with age, sex, co-morbidities, and surgical intervention matched patients who received no IMPCT consult. The outcomes of interest were post-operative complications, delays in surgery, and length of stay.Results: From 2015-2017, 71 IMPCT and 129 control patients were identified. The average age (73.7 vs. 74.5 years, p=0.57) and male gender (66% vs.70%, p=0.60) between the two groups were similar. Deaths in the IMPCT and control groups were not different, 4 vs. 5, p=0.57. Post-operative complications occurred in 59% of IMPCT patients compared with 19% of control patients (p<0.01) due to more cardiac, renal and delirium issues, p<0.01. Delays in surgery occurred in 62% of IMPCT and 40% control patients, p<0.01. The need for medical optimization in IMPCT (34%) versus control (6%) patients was the primary reason for delay, p<0.01. However, the average days of delay to OR was not different (4.9 vs. 4.9, p=0.97) between the two groups, nor was the average length of stay for the two groups, (16.2 vs. 9.5 days, p=0.16). Conclusion:More postop complications and delays to surgery were seen in patients who had an IMPCT consult compared with matched controls. In-hospital death, average days of delay to surgery and length of stay was not different.