Advertisement

Implementation of day of surgery admission for rectal cancer surgery in Ireland following a national centralisation programme

  • Ian Stephens
  • Claudine Murphy
  • Ian S. Reynolds
  • Shaheel Sahebally
  • Joseph Deasy
  • John P. Burke
  • Deborah A. McNamara
Original Article

Abstract

Background

Centralisation of rectal cancer surgery has altered the delivery of colorectal cancer care in Ireland. This has resulted in an increased demand for elective surgical beds in designated centres.

Aim

This study aimed to assess if day of surgery admission (DOSA), in conjunction with implementation of a coordinated enhanced recovery pathway can reduce length of stay following elective rectal cancer resection.

Methods

This is a retrospective review from a single institution. Our prospectively maintained Dendrite® Database was interrogated. Three time points were analysed across a 7-year period (2011, 2012, 2016). The first predates the introduction of a dedicated DOSA programme, the next was directly thereafter, and the final was 5-years post-implementation. These dates coincide with the centralisation of rectal cancer surgery to this centre. Outcomes included unadjusted length of stay and rates of DOSA pre-and post-implementation of the programme.

Results

The introduction of a DOSA pathway resulted in a fivefold increase in day of surgery admissions and a related 3-day reduction in average length of stay within a single year of implementation. This further improved in 2016, showing an almost 83% increase (15.90–98.50%) in day of surgery admission and a reduction in average length of stay from 16.4 to 12.4 days when compared to 2011.

Conclusions

Despite an increase in caseload of 54%, an estimated 272 bed days were saved. This demonstrated that DOSA is sustainable and highly effective in tackling the increased inpatient bed demands associated with the growing requirement for elective surgery.

Keywords

Centralisation Day of surgery admission Ireland Length of stay Rectal cancer 

Notes

Author contributions

Study concept and design: D.A. McNamara

Study materials: I. Stephens

Data collection: I. Stephens and C. Murphy

Data analysis: I. Stephens and I.S Reynolds

Manuscript preparation: All authors

Manuscript review: All authors

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Department of Health and Children (2006) A strategy for cancer control in Ireland. National Cancer ForumGoogle Scholar
  2. 2.
    Burke JP, Coffey JC, Boyle E, Keane F, McNamara DA (2013) Early outcomes for rectal cancer surgery in the republic of Ireland following a national centralization program. Ann Surg Oncol 20(11):3414–3421CrossRefGoogle Scholar
  3. 3.
    Boyle E, Timmons A, Al-Akash M, Kennedy AM, O'Grady H, Hill AD et al (2011) The management of rectal cancer in Ireland in 2007--room for improvement? Surgeon 9(4):179–186CrossRefGoogle Scholar
  4. 4.
    Comber H, Sharp L, Timmons A, Keane FB (2012) Quality of rectal cancer surgery and its relationship to surgeon and hospital caseload: a population-based study. Color Dis 14(10):e692–e700CrossRefGoogle Scholar
  5. 5.
    National Cancer Control Programme (2014) Report on the implementation of “a strategy for cancer control in Ireland 2006”. Health Service ExecutiveGoogle Scholar
  6. 6.
    Bao H, Yang F, Su S, Wang X, Zhang M, Xiao Y, Jiang H, Wang J, Liu M (2016) Evaluating the effect of clinical care pathways on quality of cancer care: analysis of breast, colon and rectal cancer pathways. J Cancer Res Clin Oncol 142(5):1079–1089CrossRefGoogle Scholar
  7. 7.
    Sun SX, Leung AN, Dillon PW, Hollenbeak CS (2015) Length of stay and readmissions in mastectomy patients. Breast J 21(5):526–532CrossRefGoogle Scholar
  8. 8.
    Spanjersberg W, Reurings J, Keus F, van Laarhoven C (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev Art. No.: CD007635Google Scholar
  9. 9.
    Teeuwen PH, Bleichrodt RP, de Jong PJ, van Goor H, Bremers AJ (2011) Enhanced recovery after surgery versus conventional perioperative care in rectal surgery. Dis Colon Rectum 54(7):833–839CrossRefGoogle Scholar
  10. 10.
    Stephens I, Stuart C, Stephens R, McCormick P, Larkin J, Mehigan B (2017) Trends in surgical mortality following colorectal resection between 2002 and 2012: a single-centre, retrospective analysis. Ir Med J 110(6):578PubMedGoogle Scholar
  11. 11.
    Department of Health (2017) National cancer strategy 2017-2026. National cancer control programmeGoogle Scholar
  12. 12.
    Uña E, López-Lara F (2010) Pilot study of a clinical pathway implementation in rectal cancer. Clin Med Insights Oncol 4:111–115CrossRefGoogle Scholar
  13. 13.
    Rothwell LA, Bokey EL, Keshava A, Chapuis PH, Dent OF (2006) Outcomes after admission on the day of elective resection for colorectal cancer. ANZ J Surg 76(1–2):14–19CrossRefGoogle Scholar
  14. 14.
    Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94(2):224–231CrossRefGoogle Scholar
  15. 15.
    Hendry PO, Hausel J, Nygren J, Lassen K, Dejong CH, Ljungqvist O et al (2009) Determinants of outcome after colorectal resection within an enhanced recovery programme. Br J Surg 96(2):197–205CrossRefGoogle Scholar
  16. 16.
    Gash KJ, Greenslade GL, Dixon AR (2012) Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates. Color Dis 14(10):1287–1290CrossRefGoogle Scholar
  17. 17.
    Byrne BE, Branagan G, Chave HS (2013) Unselected rectal cancer patients undergoing low anterior resection with defunctioning ileostomy can be safely managed within an Enhanced Recovery Programme. Tech Coloproctol 17(1):73–78CrossRefGoogle Scholar
  18. 18.
    Hardt J, Schwarzbach M, Hasenberg T, Post S, Kienle P, Ronellenfitsch U (2013) The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care. Int J Color Dis 28(7):1019–1026CrossRefGoogle Scholar
  19. 19.
    Sehgal R, Hill A, Deasy J, McNamara DA, Cahill RA (2012) Fast-track for the modern colorectal department. World J Surg 36(10):2473–2480CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  • Ian Stephens
    • 1
  • Claudine Murphy
    • 1
  • Ian S. Reynolds
    • 1
  • Shaheel Sahebally
    • 1
  • Joseph Deasy
    • 1
  • John P. Burke
    • 1
  • Deborah A. McNamara
    • 1
  1. 1.Department of Colorectal SurgeryBeaumont HospitalDublin 9Ireland

Personalised recommendations