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Cirugía Plástica Ibero-Latinoamericana

On-line version ISSN 1989-2055Print version ISSN 0376-7892


MONTERO RUIZ, Eduardo et al. Comanagement with Internal Medicine in a Plastic Surgery Service. Assessment of its influence on care quality. Cir. plást. iberolatinoam. [online]. 2021, vol.47, n.2, pp.173-178.  Epub Aug 02, 2021. ISSN 1989-2055.

Background and objective.

The age and comorbidity of patients admitted to Plastic Surgery are increasing, leading to increased consultations/referrals to Internal Medicine which do not reach the required effectiveness. An alternative is comanagement: shared responsibility and authority between two specialists in the management of a hospitalized patient.

We study the effect of comanagement on Plastic Surgery.


Retrospective observational study of patients ≥16 years old admitted in Plastic Surgery 17/10/2017 and 31/12/2019, with comanagement with Internal Medicine since 17/10/2018. We analyze age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of diagnoses at discharge, Charlson comorbidity index, deaths, urgent readmissions and length of stay.


Patients with comanagement were older (2.2 years, 95% CI 0.2 to 4.1), higher Charlson (1.3; 95% CI 0.9 to 1.6), higher number of diagnoses (3.9; 95% CI 3.4 to 4.4) and higher administrative weight (0.17; 95% CI 0.08 to 0.27). On adjustment, comanagement reduced Plastic Surgery length of stay by 24.1%, -1.3 days (95% CI -2.6 to -0.1), 60% urgent readmissions (OR 0.4; 95% CI 0.2 to 0.9) and 30% mortality, not significant. The decrease in length of stay implies a Plastic Surgery savings of at least € 489.731,11.


Patients admitted to Plastic Surgery are increasing in age and comorbidity. Comanagement in which an internist in addition to the plastic surgeon treats patients just as he does in the Internal Medicine ward, is associated, in our experience, with reduced length of stay and costs similar to those observed in other surgical services.

Keywords : Comanagement; Plastic Surgery; Internal medicine.

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