Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery

Abstract

Aim The present database study aimed to identify patients with a longer postoperative length of stay (LOS) or patients readmitted and to characterize both groups based on perioperative factors. Method A retrospective review of the Danish Colorectal Cancer Group database and a local database was performed of all patients undergoing elective resection for colorectal cancer in a 25‐month period. The primary outcome was the number of patients with a prolonged hospital stay (LOS ≥ 10 days after the primary operation) and readmissions within 30 days after discharge. Results A total of 372 patients with colon resection and 215 patients with rectal resection were included. Patients undergoing colonic resection had a rate of prolonged hospital stay of 10.6% and a readmission rate of 13.7%; prolonged hospital stay was significantly associated with age ≥ 76 years and those who underwent a conversion from a laparoscopic procedure. Patients undergoing rectal cancer resection had a rate of prolonged hospital stay of 17.7% and a readmission rate of 14.0%; Charlson comorbidity score (CCS) ≥ 2, total mesorectal excision (TME) and laparoscopic conversion were significantly associated with prolonged hospital stay, and American Society of Anesthesiologists (ASA) score ≥ 3, TME and a duration of surgery ≥ 300 min were significantly associated with readmission. Conclusion In patients with colon cancer, older age and conversion to open surgery were associated with prolonged hospital stay. In patients with rectal cancer, CCS ≥ 2, TME and conversion were associated with prolonged hospital stay, and a preoperative ASA score ≥ 3, TME and a duration of surgery ≥ 300 min were associated with readmission.

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

“…With regards to ASA, Bennedsen et al [17] found that an ASA score ≥ 3 was significantly associated with 30-day readmission in an enhanced recovery after surgery cohort undergoing colorectal surgery, while our data showed no statistically significant association.…”

“…There were some discrepancies among some of the previous publications, and between previously published results and those of the current study, including the influence on readmission of age [2, 11, 12], BMI [13–15], gender [16], ASA score [17] or LOS [20, 21]. Randomised studies on beyond-TME surgery should address this aspect in details.…”

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

“…Minimally invasive laparoscopic surgery (Pecorelli et al., 2017) and anorectal approach contribute to a better recovery and a lower risk of readmission and complications severity (Keller et al., 2014; Lawrence et al., 2013; Wood et al., 2018; Yuen et al., 2016). Inversely, stoma creation surgery, rectal surgery, total mesorectal excision and longer surgical procedures are related to a higher risk of emergency room consultation (Wood et al., 2018) and the readmission (Bennedsen et al., 2018; Shah et al., 2017; Wood et al., 2018; Yuen et al., 2016). Abdominoperineal resection of the rectum is associated with several dimension of poor recovery at one month (Jakobsson et al., 2016).…”

“…However, younger patients may be more stressed at home (Partoune et al., 2017). A high American Society of Anesthesiologists (ASA) score (an indicator of poor physical status) is another characteristic that increases the risk of readmission (Bennedsen et al., 2018; Keller et al., 2014) and postoperative morbidity (Feroci et al., 2013). Even if obesity is associated to a higher ASA score (Chand et al., 2015), only extreme body mass index patients have a higher risk of readmission (Wood et al., 2018).…”

Evaluation of Enhanced Recovery After Following a Surgical Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

“…In the present study, the mean length of hospital stay was significantly shorter for patients treated using this protocol than for patients treated without the protocol; these results are consistent with those reported by Teixeira et al (19) ,Pisarska et al (20) and Bennedsen et al . (21) in their studies comparing patients who were and were not treated using this protocol. An essential component of most ERAS pathways is multimodal pain management.…”