# The Role of Internal Medicine or Hospitalist Co-Management in Surgical Specialties: Implications for Adult and Elderly Plastic Surgery Patients

## TL;DR

This paper explores how involving internal medicine specialists in plastic surgery patient care could improve outcomes for complex adult and elderly patients.

## Contribution

The paper is the first to systematically review the potential role of internal medicine co-management in plastic surgery, highlighting a gap in current research.

## Key findings

- IMS co-management in other surgical fields reduces length of stay and complications.
- Plastic surgery lacks studies on IMS co-management despite patient complexity.
- Prospective studies are needed to assess benefits in plastic surgery.

## Abstract

Background and Objectives: Patients admitted to plastic surgery units increasingly present with multimorbidity, advanced age, diabetes, cardiovascular disease, chronic wounds, and complex metabolic requirements. In several surgical specialties, internal medicine specialist (IMS) co-management has been associated with improved clinical outcomes, yet its potential role in plastic surgery remains unexplored. Materials and Methods: A narrative scoping review conducted using systematic search principles was conducted using MEDLINE, Web of Science, Scopus, and Google Scholar from inception to 1 December 2025. Search terms combined “internal medicine,” “co-management,” and “surgery.” Studies assessing outcomes of IMS involvement in surgical inpatient care were included. Data on population, intervention characteristics, and outcomes were extracted and summarized. PRISMA recommendations were used to report the study selection process. The review focuses on adult and elderly surgical inpatients, as the available evidence is not applicable for pediatric populations. Results: Twenty-two articles met the inclusion criteria. IMS co-management demonstrated consistent benefits across multiple surgical specialties, including reduced length of stay, lower complication rates, improved metabolic and cardiovascular stabilization, enhanced perioperative optimization, and decreased costs. Despite the growing complexity of plastic surgery inpatients, no studies specifically evaluated IMS co-management in this field. Conclusions: Evidence from other surgical specialties suggests that structured IMS co-management may offer substantial benefits for plastic surgery patients, particularly those with multimorbidity, diabetes, severe burns, chronic wounds, or undergoing microsurgical reconstruction. Prospective studies are needed to determine its impact on patient outcomes, resource utilization, and clinical workflows within plastic surgery.