Original Articles
26 August 2025
Early Access
https://doi.org/10.4081/itjm.2025.1886

Internal-surgical co-management in emergency surgery: proposal of an organizational model

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Hospitalist, hospital medicine, comanagement, internal medicine, surgeon
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Ombretta Para
parao@aou-careggi.toscana.it
https://orcid.org/0000-0001-5214-0345
Internal Medicine 1, University Hospital of Careggi, Florence; PhD Research Program in “Clinical and Experimental Medicine and Medical Humanities”, University of Insubria, Varese, Italy.
Matteo Tomaiuolo
https://orcid.org/0000-0003-2305-053X
Hospital Health Management, University Hospital of Careggi, Florence, Italy.
Asim Raza
https://orcid.org/0009-0008-9114-0637
Internal Medicine 1, University Hospital of Careggi, Florence, Italy.
Christian Carleo
Internal Medicine 1, University Hospital of Careggi, Florence, Italy.
Lucia Lipari
https://orcid.org/0009-0005-6766-7939
Internal Medicine 1, University Hospital of Careggi, Florence, Italy.
Alessio Giordano
https://orcid.org/0000-0002-9505-791X
Emergency Surgery, University Hospital of Careggi, Florence, Italy.
Giovanni Alemanno
https://orcid.org/0000-0001-6512-8732
Emergency Surgery, University Hospital of Careggi, Florence, Italy.
Paolo Prosperi
Emergency Surgery, University Hospital of Careggi, Florence, Italy.
Carlo Nozzoli
Internal Medicine 1, University Hospital of Careggi, Florence, Italy.

The perioperative care of patients undergoing emergency or urgent surgery often involves complex management, especially in elderly individuals with multiple comorbidities. Traditional consultative models, which rely on specialist referrals, may lead to fragmented care. To address this, an integrated model of medical-surgical co-management has been implemented at Careggi University Hospital. This approach emphasizes the involvement of internists in the perioperative management of surgical patients, aiming to enhance continuity of care and improve clinical outcomes. A cohort study was conducted comparing two groups of patients admitted to the Emergency Surgery Department: one group managed under the traditional model (2016-2019) and one group managed under the integrated model with internist involvement (2021-2024). Key outcomes, including length of stay, transfers to intensive care, mortality, and specialist consultations, were compared between the two cohorts. Data were collected using ICD-9-CM codes, with adjustments made for patient characteristics and procedures. The cohort managed with internist co-management (n=3427) had a significantly lower mortality rate (2.19%) and fewer transfers to intensive care units (ICU) compared to the cohort managed by surgeons alone (n=3870; 2.94% mortality, 12.3% ICU transfers). The number of specialist consultations for pulmonology, cardiology, and nephrology was also significantly reduced in the co-management group. However, no significant difference was observed in the length of stay between the two groups. The integration of internists in the management of emergency surgical patients resulted in improved clinical outcomes, including reduced mortality and fewer transfers to high-intensity care settings. While the length of stay did not change significantly, the co-management model appears to offer substantial benefits in optimizing care and resource use. Further prospective studies are needed to confirm these findings and evaluate the economic impact of this organizational model.

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Internal-surgical co-management in emergency surgery: proposal of an organizational model. (2025). Italian Journal of Medicine. https://doi.org/10.4081/itjm.2025.1886
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