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Emergency Room Visits and Readmissions Following Implementation of an Enhanced Recovery After Surgery (iERAS) Program

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Enhanced Recovery After Surgery (ERAS) guidelines have been widely promoted and supported largely due to several studies showing decreased post-operative complications and length of stay. The objective of this study was to review the emergency room (ER) visits and readmission rates and reasons for both in patients who were part of the Implementation of an Enhanced Recovery After Surgery (iERAS) program for colorectal surgery.

Methods

All patients having elective colorectal surgery at 15 academic hospitals were enrolled in the iERAS program. All patients were prospectively followed until 30 days post-discharge. Data were analyzed using descriptive statistics and multivariable analysis.

Results

A total of 2876 patients (48% female; mean 60 years old) were enrolled. Cancer was the most frequent indication (68.2%) for surgery. Overall, the median length of stay (LOS) was 5 days. Post-discharge, 359 (11.6%) of patients had a visit to the ER not requiring admission. The most common reasons for visiting the ER were surgical site infections (SSI) (34.5%), other wound complications (10.0%), and urinary tract infections (UTI) (8.6%). In addition, a smaller proportion of patients, 260 (8.2%) required readmission. The most common reasons for readmission were ileus and nausea/vomiting (26.1%), intra-abdominal abscess (23.9%), and SSI (11.5%). Patient and disease factors associated with ER visits, on multivariable analysis, included extremes of BMI (RR 1.02, 95%CI 1.01–1.04, p = 0.002), rectal surgery versus colon surgery (RR 1.34, 95%CI 1.14–1.58, p < 0.001), and open operative approach (RR 1.63, 95%CI 1.28–2.09, p < 0.001). Independent factors associated with hospital readmissions included rectal surgery (RR 1.89, 95%CI 1.34–2.77, p < 0.001), formation of a stoma (RR 1.34, 95%CI 1.04–1.74, p = 0.026), and reoperation during first admission (RR 4.60, 95%CI 3.50–6.05, p < 0.001). Length of stay of 5 days or less was not associated with ER visits or readmission (RR 0.99, 95%CI 0.72–1.35 and RR 0.91, 95%CI 0.71–1.18, respectively).

Conclusion

Following colorectal surgery using an ERAS pathway, shortened length of stay is not associated with an increased return to the ER or hospital readmission. The majority of return visits to the hospital are ER visits not requiring readmission and the predominant reason for return are surgical site infections and wound complications.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Trevor Wood, Mary-Anne Aarts, Allan Okrainec, Emily Pearsall, Ori Rotstein & Robin S. McLeod

  2. Department of Surgery, Michael Garron Hospital, Toronto, Ontario, Canada

    Mary-Anne Aarts

  3. Department of Surgery, University Health Network, Toronto, Ontario, Canada

    Allan Okrainec

  4. Institute of Health Policy Management, University of Toronto, Toronto, Ontario, Canada

    J. Charles Victor & Robin S. McLeod

  5. Zane Cohen Clinical Research Unit, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada

    Marg McKenzie & Robin S. McLeod

  6. Department of Surgery, St. Michaels Hospital, Toronto, Ontario, Canada

    Ori Rotstein

Authors
  1. Trevor Wood
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  2. Mary-Anne Aarts
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  3. Allan Okrainec
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  4. Emily Pearsall
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  5. J. Charles Victor
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  6. Marg McKenzie
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  7. Ori Rotstein
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  8. Robin S. McLeod
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Consortia

on behalf of the iERAS group

  • Shawn Forbes
  • , Hanna Tuszynska
  • , Linda Onorato
  • , Jana Macdonald
  • , Daniel Broomfield
  • , Antonio Caycedo
  • , Tony Hick
  • , Gisele Clement
  • , Steve Blakely
  • , Hugh MacDonald
  • , Janet Van Vlymen
  • , Natalie McPherson
  • , Ellie Scott
  • , Chris Schlachta
  • , Chris Harle
  • , Kristin Stillwell
  • , Amy Chambers
  • , Anand Govindarajan
  • , Naveed Siddiqui
  • , Elaheh Sarvi
  • , Anisa Memon
  • , Peter Stotland
  • , Darryl Irwin
  • , Michelle Wong
  • , Lucia Vanta
  • , Darlene Fenech
  • , Beverly Morningstar
  • , Elaine Avila
  • , Anna Speke
  • , Ori Rotstein
  • , Ahmed Hamdy
  • , Joan Park
  • , Jacinta Reddigan
  • , Margherita Cadeddu
  • , Cyndie Horner
  • , Mary Dunn
  • , Tobi Adeyemo
  • , David Lindsay
  • , Maureen Savoie
  • , Laura Tomat
  • , Rebecca Auer
  • , Michael Szeto
  • , Maureen McGrath
  • , Manahil Sadiq
  • , Julie Sinclair
  • , Gabriel Mapeso
  • , Scott Bonneville
  • , Deboura Olson
  • , Erin Woodbeck
  • , Mary-Anne Aarts
  • , Chris Saby
  • , Tatjana Sukovic
  • , Catherine O’Brien
  • , Stuart McCluskey
  • , Theresa Zamora
  • , Allan Okrainec
  • , Francis Cheung
  • , Carol Lopez
  •  & Afshin Mosavi Mirkolaei

Corresponding author

Correspondence to Robin S. McLeod.

Ethics declarations

Funding

This work is funded by the Council of Academic Hospitals of Ontario.

Additional information

All authors meet the guidelines of the International Committee of Medical Journal Editors (ICMJE) criteria for authorship.

Dr. McLeod holds the Angelo and Alfredo De Gasperis Families Chair in Colorectal Cancer and IBD Research.

Appendix

Appendix

on behalf of the iERAS group

Shawn Forbes

Hanna Tuszynska

Linda Onorato

Jana Macdonald

Daniel Broomfield

Antonio Caycedo

Tony Hick

Gisele Clement

Steve Blakely

Hugh MacDonald

Janet Van Vlymen

Natalie McPherson

Ellie Scott

Chris Schlachta

Chris Harle

Kristin Stillwell

Amy Chambers

Anand Govindarajan

Naveed Siddiqui

Elaheh Sarvi

Anisa Memon

Peter Stotland

Darryl Irwin

Michelle Wong

Lucia Vanta

Darlene Fenech

Beverly Morningstar

Elaine Avila

Anna Speke

Ori Rotstein

Ahmed Hamdy

Joan Park

Jacinta Reddigan

Margherita Cadeddu

Cyndie Horner

Mary Dunn

Tobi Adeyemo

David Lindsay

Maureen Savoie

Laura Tomat

Rebecca Auer

Michael Szeto

Maureen McGrath

Manahil Sadiq

Julie Sinclair

Gabriel Mapeso

Scott Bonneville

Deboura Olson

Erin Woodbeck

Mary-Anne Aarts

Chris Saby

Tatjana Sukovic

Catherine O'Brien

Stuart McCluskey

Theresa Zamora

Allan Okrainec

Francis Cheung

Carol Lopez

Afshin Mosavi Mirkolaei

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Cite this article

Wood, T., Aarts, MA., Okrainec, A. et al. Emergency Room Visits and Readmissions Following Implementation of an Enhanced Recovery After Surgery (iERAS) Program. J Gastrointest Surg 22, 259–266 (2018). https://doi.org/10.1007/s11605-017-3555-2

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  • DOI: https://doi.org/10.1007/s11605-017-3555-2

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