title: Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients.
abstract: OBJECTIVE
  Among a national cohort of surgical patients, the authors analyzed the association between medical follow-up during the first postsurgical year and survival during the second postsurgical year.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  US Veterans Hospitals.
  
  
  METHODS
  The study included adults who received surgical care in any Veterans Health Administration facility from 2006 to 2011 who were discharged within 10 days of surgery and who survived for at least 1 year postoperatively.
  
  
  METHODS
  None.
  
  
  RESULTS
  The association between the receipt of nonsurgical ambulatory medical care during the first postoperative year and the hazard of death during postsurgical year 2 was measured. Among 236,200 veterans, 93.2% received a nonsurgical medical follow-up visit in postsurgical year 1; of those, 5.1% died during postsurgical year 2. This compares with 9.4% year-2 mortality among patients lacking year-1 medical follow-up (p<0.0001). After adjustment for confounders, medical follow-up in postoperative year 1 again was associated with a significantly lower hazard of death in postoperative year 2 (hazard ratio 0.71; 95% confidence interval 0.66-0.78). Sensitivity analyses examining patient subgroups stratified by procedural specialty demonstrated comparable findings. The results were robust under a variety of simulated scenarios of unmeasured confounding.
  
  
  CONCLUSIONS
  Within a national cohort of US veterans who presented for surgery, those who received nonsurgical ambulatory follow-up during the first postoperative year demonstrated lower all-cause mortality in the subsequent postoperative year than those who did not receive the same type of follow-up care. Interventions focused on postoperative care coordination of outpatient medical follow-up may have the potential to improve long-term postoperative survival.
authors.affiliation: Department of Anesthesiology, Yale School of Medicine. Electronic address: robert.schonberger@yale.edu.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Schonberger
authors.affiliation: Department of Anesthesiology, Yale School of Medicine; Yale Center for Analytical Sciences, Yale School of Public Health; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.affiliation: Department of Anesthesiology, Yale School of Medicine; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.affiliation: Department of Anesthesiology, Yale School of Medicine; VA Connecticut Healthcare System, West Haven, CT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*; D058014:Veterans Health
keywords: care transitions; healthcare delivery; perioperative surgical home; postoperative care