Perioperative Surgical Home Model Improves Outcomes in Crohn’s Disease Patients Undergoing Disease-Related Surgery

Abstract

Background. To evaluate Perioperative Surgical Home (PSH) practice model implementation in Crohn’s disease (CD) patients undergoing disease-related surgery. Methods. A retrospective analysis of CD patients requiring disease-related surgery in the Shanghai Ninth People’s Hospital was undertaken. Subjects were divided into a non-PSH group consisting of 49 patients (June 2016 to November 2017) and a PSH group consisting of 72 patients (December 2017 until May 2019). Conventional treatment was used for the non-PSH group, while in the PSH group, a standardized pre- and postoperative management routine was employed. The postoperative lengths of stay and incidences of postoperative complications were analyzed. Results. There were no significant differences in demographics, reasons for surgery, preoperative BMIs, and preoperative hemoglobin between the two groups (P>0.05). The overall incidence of complications in the PSH group was dramatically lower than that in the non-PSH group (26.4% vs. 44.9%, P=0.035). In the PSH group, postoperative length of stay was significantly shorter than that in the non-PSH group (11.5±5.7 vs. 9.0±6.8, P<0.001). Conclusions. The PSH conditioning routine in CD patients undergoing disease-related surgeries suggests a trend of fewer postoperative complications and shorter lengths of hospital stay. The PSH model may have clinical advantages when applied to CD patients.

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis

“…The most common CCSRs, which cumulatively accounted for just over half of the increase in the MS-DRG weighting factor, in descending order of the point estimates, were spine fusion, heart valve surgery, colectomy, pulmonary resection, coronary artery bypass graft, and hip and knee arthroplasty (Table 3). These CCSRs include the surgical procedures commonly targeted for interventions to reduce complications [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], confirming the face validity of our method of using the MS-DRG weighting factor to measure incremental societal costs of complications. The impact of each additional case with an escalation in the MS-DRG differed greatly among the CCSRs.…”

“…Efforts to validate the cost-effectiveness of such expansion of anaesthesiologists' role outside the operating room proper have generally been conducted at single institutions, with most patients cared for by small numbers of surgeons [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This observation should not be construed as a criticism but rather reflects the complexity of PSH implementation within organizations and the relatively small numbers of surgeons within each surgical subspecialty at most individual hospitals.…”

“…Most studies of the PSH and ERAS protocols have involved one or only a few hospitals, which is likely to continue[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The consequence is that, in practice, interventions often have been applied principally to a few surgeons' patients.…”

Previous Intestinal Resection Is Associated with Postoperative Complications in Crohn’s Disease: A Cohort Study

“…Retrospective studies have tried to evaluate the risk factors for postoperative complications and have reported that advanced age, lower body mass index (BMI), poor nutritional status, higher American Society of Anesthesiologists (ASA) Physical Status Classification System score (ASA score), and the CD complications of abscess or intestinal fistula formation were related to increased postoperative complications [ 10 – 14 ]. Patients' overall condition has been improved through preoperative treatment and perioperative surgical home practice according to our previous research [ 15 ]. Because of the high CD recurrence rate and their complications, more than 50% of patients with CD will experience surgical recurrence within 10 years after the first operation [ 16 ].…”