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Factors influencing discharge disposition after colectomy

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Abstract

Background

Factors associated with discharge destination after colectomy despite accounting for surgical morbidity have not previously been well characterized. This study aims to evaluate perioperative predictors for extended care after complicated and uncomplicated colectomy.

Methods

Patients admitted from home for elective colectomy were identified from the American College of Surgeons, National Surgical Quality Improvement Program, 2012–2013 general and colectomy-targeted datasets. Patients who were discharged home (DH) were compared to those discharged to facility (DF) for patient, disease, treatment, and pre-discharge postoperative adverse events. Patients without any 30-day postoperative complication were similarly compared.

Results

Of 19,527 patients undergoing elective colectomy, 18,128 (92.8%) were discharged home and 1399 (7.2%) patients to other facilities. When there was no postoperative complication, these rates were 96.3 and 3.7%, respectively. On multivariable analysis, factors associated with DF included female gender, functional dependence, weight loss, ASA class ≥ 3, open and stoma surgery, and development of postoperative complications. For patients without postoperative complications, increasing age, functional dependence, and ASA score ≥ 3 were associated with DF. Preoperative bowel preparation, albumin, a minimally invasive surgical approach, and length of stay < 5 days were significantly associated with reduced DF.

Conclusion

The majority of perioperative factors associated with extended care after colectomy are patient driven. The adoption of oral antibiotics as bowel preparation, minimally invasive surgery, and accelerated recovery protocols may reduce post-acute care placement after elective colectomy.

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Funding

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Authors and Affiliations

  1. Division of Colorectal Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA

    Ahmed M. Al-Mazrou & Ravi P. Kiran

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA

    Codruta Chiuzan

Authors
  1. Ahmed M. Al-Mazrou
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  2. Codruta Chiuzan
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  3. Ravi P. Kiran
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Corresponding author

Correspondence to Ravi P. Kiran.

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Disclosures

Ahmed M. Al-Mazrou, Codruta Chiuzan, and Ravi P. Kiran have no conflict of interest or financial ties to disclose.

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Al-Mazrou, A.M., Chiuzan, C. & Kiran, R.P. Factors influencing discharge disposition after colectomy. Surg Endosc 32, 3032–3040 (2018). https://doi.org/10.1007/s00464-017-6013-z

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  • DOI: https://doi.org/10.1007/s00464-017-6013-z

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