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Surgical comanagement

Hugo Quinny Cheng, MD
Kevin J Bozic, MD, MBA
Section Editors
Andrew D Auerbach, MD, MPH
Hilary Sanfey, MD
Deputy Editors
Daniel J Sullivan, MD, MPH
Kathryn A Collins, MD, PhD, FACS


Comanagement is a model that allows the generalist, typically a hospitalist, to share the responsibility, authority, and accountability for the care of surgical patients. The popularity of comanagement has grown in parallel with the hospitalist movement. Between 2001 and 2006, the comanagement of surgical patients by hospitalists increased by over 11 percent per year [1]. This increase is due to several factors, including an increasing number of patients with advance aged or serious medical disease undergoing surgery [2,3].

This topic will provide an overview of the principles of surgical comanagement. The principles of traditional medical consultation are discussed elsewhere. (See "Overview of the principles of medical consultation and perioperative medicine".)


Medical comanagement of surgical patients can take a variety of forms. Often, the surgeon remains the attending of record, while the comanaging physician is given wide latitude to manage the perioperative care of surgical patients. Alternatively, these roles are reversed, and the surgical patient is admitted to the comanaging physician, who assumes primary responsibility for care. In this case, the surgeon is often only responsible for managing issues related to the surgical diagnosis and procedure. Regardless of the specific arrangement, comanagement has features that distinguishes it from traditional medical consultation (table 1).

Negotiated relationship — In traditional medical consultation, the role of the consultant is either defined at the time the consultation is requested or based upon presumed mutual understanding [4]. Comanagement relationships are far more formal [5]. Protocols and expectations are negotiated between the primary and comanaging physician and often delineated in a written comanagement agreement prior to initiating patient care. They involve not only the individual surgeon and comanaging physician but the entire surgical and hospital medicine groups as well as other potential partners, such as hospital administrators.

Selection of patients and reasons for referral — With traditional consultation, the surgeon retains sole authority and responsibility for identifying patients who would benefit from evaluation by the consultant. The surgeon also determines the scope of the consultant's involvement. Consultation etiquette constrains the ability of the consultant to address issues beyond those specified by the referring provider [4,6]. (See "Overview of the principles of medical consultation and perioperative medicine", section on 'Performing the consultation'.)

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Literature review current through: Dec 2017. | This topic last updated: Mar 29, 2016.
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