title: Early Physician Follow-Up and Out-of-Hospital Outcomes After Cerebral Aneurysm Treatment in Elderly Patients.
abstract: BACKGROUND
  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.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire. Electronic address: kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: Dan
authors.initials: D
authors.lastname: Gottlieb
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: Yin
authors.initials: Y
authors.lastname: Su
authors.affiliation: Department of Radiology, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.affiliation: Department of Neurosurgery, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D006278:Medicare; D019635:Neurosurgical Procedures; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D057216:Propensity Score; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014481:United States
keywords: Cerebral aneurysm; Follow up; Medicare; Postacute care; Subarachnoid hemorrhage