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08.10.2019 | Original Article | Ausgabe 11/2019

International Journal of Colorectal Disease 11/2019

ERAS, length of stay and private insurance: a retrospective study

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 11/2019
Autoren:
Diana A. Celio, Roberto Poggi, Mike Schmalzbauer, Raffaele Rosso, Pietro Majno, Dimitri Christoforidis
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Abstract

Purpose

Hospital discharge after colorectal resection within an Enhanced Recovery After Surgery (ERAS) program occurs earlier compared to standard-care postoperative pathways but often later than what objective criteria of “readiness for discharge” could allow. The aim of this study was to analyse reasons and risk factors of such discharge delay.

Methods

All elective patients admitted for colorectal resection at the regional Hospital of Lugano in 2014 and 2015 were included. The postoperative day on which patients fulfilled consensus agreed criteria (according to Fiore) for readiness for discharge (POD-F) and the effective day of discharge (POD-D) were determined. We analysed the reasons for discharge delay (POD-D>POD-F) and performed univariate and multivariate analysis to determine risk factors.

Results

One hundred thirty-eight patients were included in the study. Median POD-F was 5 (2–48) days, POD-D was 6 (3–50) days. In 94 patients, POD-D occurred later than POD-F with a median delay of 1 (1–11) days. Reasons for discharge delay were insufficient social support in 13 (14%), patient’s preference in 39 (41%) and medical team preference in 41 (44%). Private insurance (OR 2.61, 95%CI 1.08–6.34, p = 0.034) and patient discharged on a day other than Monday (OR 2.94, 95%CI 1.16–7.14, p = 0.023) were independent predictors for discharge delay.

Conclusion

Even when objective criteria for readiness for discharge have been fulfilled, patients and/or doctors often do not feel comfortable with hospital discharge at this time point. Length of stay, even within an ERAS program, is still influenced by several non-medical factors and is therefore not a precise surrogate marker of outcomes.

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