Daniel J Borsuk1, Ahmed AL-Khamis, MD1, Dimin Zhou, MS2, Ina Zamfirova, MS3, Christina Warner, MD1, Kunal Kochar, MD1, Slawomir J Marecik, MD1. 1Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA, 2Chicago Medical School, North Chicago, Illinois, USA, 3James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
INTRODUCTION: Enhanced recovery after surgery (ERAS) programs aim to standardize perioperative care to reduce perioperative morbidity and cost. Our study examined post-hospital discharge surveillance programs (PHDSP) in reducing avoidable readmissions and emergency department (ED) visits in ERAS patients.
METHODS AND PROCEDURES: Retrospective review included right hemicolectomy, left hemicolectomy, subtotal colectomy, total colectomy, or low anterior resection cases between 2015–2017 at a tertiary care hospital. Demographics, emergency department (ED) visits, 30-day readmissions, and patients’ participation in PHDSP via smartphone application were assessed.
RESULTS: Of 298 patients who underwent colectomy, 131 patients utilized PHDSP and 167 patients did not. Both non-surveillance (NS) and active surveillance (AS) groups had similar preoperative baseline characteristics with respect to age (62±13 years and 64±14 years, respectively) and sex (57% and 56% females, respectively). Length of hospital stay at index surgery was longer in the NS compared to AS group, 4.44±2.71 vs. 2.72±2.67 days, respectively (P < 0.001). Minor and major complication rates post discharge from index surgery were comparable, 11.5% and 6% respectively in the AS group compared to 9.5% and 8% in the NS group. There were 23 (13.8%) NS group ED visits with 19 resulting in readmission. Two patients were direct admissions to the floor, totaling to 21 readmissions (12.5%). Three readmissions would have been avoidable had PHDSP been available. Of the 131 AS patients, there were 17 ED visits (13%) resulting in 9 readmissions. Three patients were admitted directly to the floor, resulting in 13 total readmissions (10%). Half (47%) of the ED visits were a result of major complications and as such were unavoidable despite using the mobile application. The rest of the ED visits were avoidable had the mobile application been appropriately used by the patient. Moreover, 15 AS patients (11%) used the mobile application to communicate significant clinical complaints and were managed without ED visits or re-admission. The AS group had significantly fewer 13 (10%) patients visit the ED compared to 21 (12.6%) NS patients (P = 0.045).
CONCLUSIONS: We found that PHDSP allows many post-operative issues to be resolved at home or in outpatient settings without ER visits or readmission. This indicates that PHDSP is a valuable adjunct to the ERAS program, as it establishes a cost-effective and convenient line of communication between patients and their surgical team, many of whom are discharged early from the hospital at index surgery because of this tool availability.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87447
Program Number: S128
Presentation Session: ERAS Session
Presentation Type: Podium