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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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Graphical abstract

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Acknowledgements

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). https://doi.org/10.1007/s00464-019-06725-x

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Keywords

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