Factors influencing discharge disposition after colectomy

Abstract

The majority of perioperative factors associated with extended care after colectomy are patient driven. The adoption of oral antibiotics as bowel preparation, minimally invasive surgery, and accelerated recovery protocols may reduce post-acute care placement after elective colectomy.

I want to go home: should we abandon open surgery for treatment of rectal prolapse? Consideration of discharge destination following surgery for rectal prolapse

“…This study used NSQIP in a similar manner to determine if operative approach, in addition to other variables, influenced the discharge destination for patients undergoing rectal prolapse surgery. The nomogram in Figure 1 displays risk factors for requiring postoperative PAC that are consistent with risk factors seen in other studies, including advanced age, MIS, comorbidities and postoperative complications [18,20–23].…”

“…This study used NSQIP in a similar manner to determine if operative approach, in addition to other variables, influenced the discharge destination for patients undergoing rectal prolapse surgery. The nomogram in Figure 1 displays risk factors for requiring postoperative PAC that are consistent with risk factors seen in other studies, including advanced age, MIS, comorbidities and postoperative complications[18,[20][21][22][23].The cost of PAC after surgery varies by hospital system. One study reported a cost of USD 3345-6104 after colectomy, with the strongest Nomogram for prediction of morbidity: the nomogram demonstrates the likelihood of postoperative morbidity based on total points accumulated based on surgical approach (MIS, minimally invasive), functional status, American Society of Anesthesiologists (ASA) classification, body mass index (BMI) and smoking (c-statistic 0.614)…”

“…In an era where immediate postoperative outcomes and discharge destination are increasingly emphasized as benchmarks for quality and value, the most successful and safe surgical treatment for rectal prolapse should be re-evaluated [17,18]. Abdominal approaches are believed to have lower risks of recurrence than perineal approaches [1,4,19]; however, no prospective randomized trials have demonstrated a significant difference in long-term recurrence rates [3][4][5].…”

“…This study found that 7.33% of all patients who undergo surgical repair of rectal prolapse required PAC; however, that number increases to almost 9% with open abdominal procedures. A recent study utilized NSQIP to determine risk factors for increased level of care after colectomy and found that patient factors such as being female, functional status, weight loss, ASA class, open surgery and postoperative complications were associated with discharge to a facility, while oral antibiotics as bowel preparation, MIS and accelerated recovery protocols were associated with discharge to home [18]. This study used NSQIP in a similar manner to determine if operative approach, in addition to other variables, influenced the discharge destination for patients undergoing rectal prolapse surgery.…”

Transition from hospital to home after elective colorectal surgery performed in an enhanced recovery program: An integrative review

“…While evidence support the utility of ERAS to accelerate surgical patients discharge from hospital to home, the benefit of such programmes to avoid hospital readmission remains to be demonstrated (Greco et al., 2014; Lv et al., 2012; Varadhan et al., 2010; Zhuang et al., 2013). In fact, several studies have reported high readmission rates (from 9%–25%) in the 30 days following elective colorectal surgery (Adamina et al., 2011; Al‐Mazrou et al., 2018; Damle & Alavi, 2016; Lawson et al, 2014). These statistics suggest some difficulties in colorectal patients’ transition from hospital to home.…”