Measuring In-hospital Recovery after Colorectal Surgery: A Comparison Between Hospital Length of Stay and Time to Readiness for Discharge

Saba Balvardi, MS, Julio F Fiore Jr., PhD, Tanya Castelino, MSc, Nicolò Pecorelli, MD, Petru Niculiseanu, MD, Senders Liberman, MD, Patrick Charlebois, MD, Berry Stein, MD, Franco Carli, MPhil, Nancy Mayo, PhD, Liane S Feldman, MD. McGill University

INTRODUCTION: Hospital length of stay (LOS) is often used as a measure of in-hospital recovery but may be confounded by organizational factors. Evidence suggests that the time to achieve discharge criteria (time to readiness for discharge (TRD)) provides a superior index of recovery in traditional care settings; however, enhanced recovery pathways (ERPs) may reduce care process variances and differences between LOS and TRD may become irrelevant. Our study aimed to contribute evidence for the construct validity of TRD and LOS as measures of recovery after colorectal surgery in the context of an established ERP.

METHODS AND PROCEDURES: This study involved 100 consecutive patients undergoing elective colorectal resection (mean age 65, 57% male). Construct validity was evaluated by testing a priory hypotheses that LOS and TRD are longer in patients (1) undergoing open vs. laparoscopic surgery, (2) with lower vs. higher physical status, (3) with severe vs. no/less severe comorbidities, (4) with postoperative complications vs. no complications, (5) undergoing rectal vs. colon surgery, (6) older (≥75) vs. younger, (7) with stoma vs. no stoma and (8) with inflammatory bowel disease (IBD) vs. no IBD. Study design was guided by the COSMIN consensus on measurement properties.

RESULTS: Median TRD and LOS was 3 days [IQR 2-4] and 3 days [IQR 3-5], respectively. 44% of patients stayed in hospital after TRD (median 1 day longer). For both TRD and LOS, 6 out of 8 hypotheses were supported (Table).

CONCLUSIONS: This study contributes evidence to the construct validity of TRD and LOS as measures of in-hospital recovery, suggesting that they can be interchangeably used in context of established ERPs. Our findings support the role of ERPs in decreasing process of care variances that impact LOS, allowing timely discharge once discharge criteria are achieved.