Early Red Flags Associated with Delayed Discharge in Patients Undergoing Gastrectomy: Analysis of Perioperative Variables and ERAS Protocol Items

Abstract

Background Enhanced Recovery After Surgery (ERAS) perioperative pathways are safe and effective for patients undergoing gastrectomy. However, adherence to these protocols varies and is generally underreported. This retrospective study aimed to assess whether perioperative variables or deviation from ERAS items is associated with delayed discharge after gastrectomy. Methods All patients undergoing gastrectomy at our institution were managed with a standardised perioperative pathway according to ERAS principles. The target length of stay was set as the ninth post‐operative day (POD). All significant variables were derived from a bivariate analysis and were entered into a logistic regression to confirm their statistical value. Results The study included 180 patients. Multivariate regression analysis revealed that incomplete immunonutrition, failure to extubate the patient at the end of surgery, intraoperative crystalloids >2150 ml and blood transfusion >268 ml, surgery duration >195 min, and failure to mobilise patients within 24 h from surgery were associated with delayed discharge. The logistic regression model was statistically significant (p < 0.001) and correctly classified 73.6% of cases. Sensitivity and specificity were 74.1% and 73.2%, respectively. Conclusions These results seem clinically significant and consistent with those of previous studies. The reported perioperative variables showed a strong relationship with the length of hospital stay.

Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

“…It might take some time before patients with malnutrition are properly stabilized. This study also supported the ndings of previous studies that patients with malnutrition have a higher rate of overall postoperative complications [11,19]. This indicated that elderly patients with malnutrition require close attention during the postoperative period, and nutritional support should be individualized for this vulnerable cohort.…”

“…Malnutrition is one of the most crucial risk factors for postoperative complications [11]. In elderly GC patients, malnutrition is often caused by frailty, absorption disorder, and a decrease in food intake [12].…”

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

“…Initially proposed by Danish surgeon, Henrik Kehle, ERAS is a multi-professional and multidisciplinary approach to the care of the surgical patient in order to obtain a rapid recovery after surgical intervention [ 11 ]. While the initial efforts focused on colorectal surgery, the basic principles have now been adopted to multiple surgical specialties [ 6 , 12 – 14 ]. ERAS protocols have been shown to be particularly beneficial for the elderly people who often have comorbidities and run a higher risk of surgical complications.…”

Enhanced Recovery After Surgery (Eras) Program for Elderly Patients With Short-level Lumbar Fusion

“…Worley et alfound that patients age 65 had an increasedrisk of inpatient morbidity (10).Initially proposed by Danish surgeon, Henrik Kehle, ERAS is a multi-professional and multidisciplinary approach to the care of the surgical patientin order to obtain a rapid recovery after surgical intervention (11). While the initial efforts focused on colorectal surgery,the basic principles now been adopted to multiple surgical specialties (6,(12)(13)(14). ERAS protocols have beenshown to be particularly bene cial for the elderly people who often haveco-morbidities and run a higher risk of surgical complications.Furthermore, these principleshave been applied in patients withtotal hip arthroplasty, total knee arthroplasty, and those with intertrochanteric fracture, who notnot only experiencedreduced hospital LOS, but also in improvement in patient care and reduced health care costs (15,16).…”