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S128: Active post discharge surveillance program as a part of Enhanced Recovery After Surgery protocol decreases emergency department visits and readmissions in colorectal patients



Enhanced Recovery After Surgery (ERAS) programs aim to standardize perioperative care to reduce morbidity and cost. Our study examined an Active Post-Discharge Surveillance (APDS) program in reducing avoidable readmissions and emergency department (ED) visits in postoperative colorectal ERAS patients.


Colectomy (right, subtotal and total) and low anterior resection cases performed at a tertiary care hospital between 2015 and 2018 were reviewed. ED visits, 30-day readmissions, and patients’ APDS participation were assessed. Our APDS followed a modern text messaging paradigm offered to all patients free-of-charge.


Of 236 patients that underwent colectomy, 123 utilized APDS and 113 did not. Overall, both non-surveillance (NS) and active surveillance (AS) groups had similar preoperative characteristics. Length of hospital stay at index surgery was longer in the NS compared to AS group, 4.7 ± 2.6 vs. 2.6 ± 2.8 days, respectively (p < 0.001). In the NS group, 16 patients visited the ED, of which 14 (14/16, 87.5%) were ultimately readmitted. One patient was directly readmitted from the surgeon’s office, resulting in a total of 15 (15/113, 13.3%) total patients readmitted by postoperative day (POD) 30. In the AS group, 9 patients visited the ED, of which 7 (7/9, 77.8%) were ultimately readmitted. One patient was directly readmitted, resulting in a total of 8 (8/123, 6.5%) total patients readmitted by POD 30. AS patients had significantly lower odds of visiting the ED when compared to NS patients (OR: 0.356; 95% CI: 0.138–0.919; p = 0.0328). Similarly, AS patients had significantly lower odds of readmission when compared to NS patients (OR: 0.343; 95% CI: 0.132–0.892; p = 0.0283).


APDS allows many postoperative issues to be resolved in outpatient settings without ER visits or readmission. This indicates APDS is a valuable ERAS adjunct by establishing a cost-effective and convenient communication line between patients and their surgical team.

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  1. 1.

    Chen J, Mackenzie J, Zhai Y, O’Loughlin J, Kholer R, Morrow E et al (2017) Preventing returns to the emergency department following bariatric surgery. Obes Surg 27:1986–1992

    Article  Google Scholar 

  2. 2.

    Benlice C, Seyidova-Khoshknabi D, Stocchi L, Hull T, Steele S, Gorgun E (2017) Decreasing readmissions by focusing on complications and underlying reasons. Am J Surg.

  3. 3.

    Parrish AB, O’Neill SM, Crain SR, Russell TA, Sonthalia DK, Nguyen VT et al (2018) An enhanced recovery after surgery (eras) protocol for ambulatory anorectal surgery reduced postoperative pain and unplanned returns to care after discharge. World J Surg.

    Article  PubMed  Google Scholar 

  4. 4.

    Weber EJ (2018) Finding value in ‘inappropriate’ visits: A new study demonstrates how variation in ED use for preventable visits can be used to detect problems with access to healthcare in our communities. Emerg Med J 35:133–134

    Article  Google Scholar 

  5. 5.

    Rossman SR, Reb CW, Danowski RM, Maltenfort MG, Mariani JK, Lonner JH (2016) Selective early hospital discharge does not increase readmission but unnecessary return to the emergency department is excessive across groups after primary total knee arthroplasty. J Arthroplasty 31:1175–1178

    Article  Google Scholar 

  6. 6.

    Carrier G, Cotte E, Beyer-Berjot L, Faucheron JL, Joris J, Slim K (2016) Post-discharge follow-up using text messaging within an enhanced recovery program after colorectal surgery. J Visc Surg 153:249–252

    CAS  Article  Google Scholar 

  7. 7.

    Abelson JS, Symer M, Peters A, Charlson M, Yeo H (2017) Mobile health apps and recovery after surgery: What are patients willing to do? Am J Surg 214:616–622

    Article  Google Scholar 

  8. 8.

    Jones D, Musselman R, Pearsall E, McKenzie M, Huang H, McLeod RS (2017) Ready to go home? patients’ experiences of the discharge process in an enhanced recovery after surgery (eras) program for colorectal surgery. J Gastrointest Surg 21:1865–1878

    CAS  Article  Google Scholar 

  9. 9.

    Kummerow Broman K, Oyefule OO, Phillips SE, Baucom RB, Holzman MD, Sharp KW et al (2015) postoperative care using a secure online patient portal: changing the (inter)face of general surgery. J Am Coll Surg 221:1057–1066

    Article  Google Scholar 

  10. 10.

    Symer MM, Abelson JS, Milsom J, McClure B, Yeo HL (2017) A mobile health application to track patients after gastrointestinal surgery: results from a pilot study. J Gastrointest Surg 21:1500–1505

    Article  Google Scholar 

  11. 11.

    Gunter R, Fernandes-Taylor S, Mahnke A, Awoyinka L, Schroeder C, Wiseman J et al (2016) Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring. JMIR MHealth UHealth 4:e113

    Article  Google Scholar 

  12. 12.

    Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen L (2015) Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol.

    Article  Google Scholar 

  13. 13.

    Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J et al (2014) Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 118:1052–1061

    Article  Google Scholar 

  14. 14.

    Rossi G, Vaccarezza H, Vaccaro CA, Mentz RE, Im V, Alvarez A et al (2013) Two-day hospital stay after laparoscopic colorectal surgery under an enhanced recovery after surgery (ERAS) pathway. World J Surg 37:2483–2489

    Article  Google Scholar 

  15. 15.

    Teeuwen PHE, Bleichrodt RP, Strik C, Groenewoud JJM, Brinkert W, van Laarhoven CJHM et al (2010) enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg 14:88–95

    Article  Google Scholar 

  16. 16.

    Keenan JE, Speicher PJ, Thacker JKM, Walter M, Kuchibhatla M, Mantyh CR (2014) The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg 149:1045

    Article  Google Scholar 

  17. 17.

    Lassen K (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg 144:961

    Article  Google Scholar 

  18. 18.

    Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842–847.e1

    Article  Google Scholar 

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We would like to thank Ina Zamfirova at the James R. & Helen D. Russell Institute for Research & Innovation at Advocate Lutheran General Hospital for her support and assistance throughout the project. We would like to acknowledge Biostatistician Nicholas A. Davis, MS at Howard Brown Health for his assistance with statistical analyses throughout the project.

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Correspondence to Daniel J. Borsuk.

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Mr. Daniel J. Borsuk, Dr. Ahmed AL-Khamis MD, Ms. Dimin Zhou MS, Dr. Christina Warner MD, Mr. Andrew J. Geiser, Dr. Kunal Kochar MD, and Dr. Slawomir J. Marecik have no conflicts of interest or financial ties to disclose.

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Borsuk, D.J., AL-Khamis, A., Geiser, A.J. et al. S128: Active post discharge surveillance program as a part of Enhanced Recovery After Surgery protocol decreases emergency department visits and readmissions in colorectal patients. Surg Endosc 33, 3816–3827 (2019).

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  • Active surveillance
  • Avoidable
  • Emergency department visits
  • Readmissions
  • ERAS