Z Gastroenterol 2023; 61(08): e591
DOI: 10.1055/s-0043-1772112
Abstracts | DGVS/DGAV
Kurzvorträge
Peritonealkarzinose
Freitag, 15. September 2023, 15:15–16:19, Saal C2.1

The use of discharge criteria to optimize patient discharge after gastrointestinal operations

B. Müssle
1   Oberschwabenklinik Ravensburg, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Ravensburg, Deutschland
,
L. Wille
2   Universitätsklinikum Carl Gustav Carus Dresden, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Dresden, Deutschland
,
J. Weitz
2   Universitätsklinikum Carl Gustav Carus Dresden, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Dresden, Deutschland
,
T. Welsch
3   Universitätsklinikum Hamburg-Eppendorf, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
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    Introduction Enhanced recovery after surgery (ERAS) programs and the current reimbursement system both aim to minimize the hospital stay. In gastrointestinal surgery, postoperative complications, gastroparesis or failure to ambulate can significantly prolong inpatient treatment.

    Aims Aim of the present study is to investigate if a discharge notification management based on predefined discharge criteria (DC) is feasible, safe and can shorten the hospital stay.

    Methods Between Jan 2018 and Aug 2018, patients who underwent major abdominal surgery at a single center were prospectively monitored (PRO group) regarding 5 DC: toleration of normal diet, bowel movement, ambulation on its own, no intravenous medication, no signs of infection (no leukocytosis and fever, C-reactive protein [CRP]<80 mg/l). If a patient met all criteria, the responsible surgical team was informed by a study nurse. Hospital stay, readmission rate, morbidity and mortality of the PRO cohort were compared with a retrospective cohort without notification system (RET).

    Results In both groups, 336 patients with a median age of 63 years (61.3% male) were included. The PRO (n=168) and RET (n=168) cohorts did not significantly differ with regard to operations (gastric, n=38; colorectal, n=130, liver, n=111; pancreatic, n=57) and basic patient characteristics. A minimally-invasive approach was done in 45%. Hospital stay, 90-day-readmission rate, morbidity and mortality were 9.5 days, 8.9%, 31.5% and 1.2% versus 9.0 days, 8.3%, 33.9% and 1.2%, respectively. Upon discharge, all 5 DC were met by 144 (85.7%, PRO) and 132 patients (78.6%, RET) after 8.7 and 9.1 days, respectively. Ambulation and a CRP<80 mg/l were restored after a median of 5 days in both groups. The mean intrahospital waiting period (IHWP) until discharge was 1.8 days (PRO) and 2.1 days (RETRO), respectively. The readmission rate was 15.8% in patients discharged without IHWP, and 5.7% with a IHWP of 1–5 days.

    Conclusion A notification system based on DC did not significantly reduce hospital stay. Frequently, patients were discharged 1–2 days after all DC were met. The 5 DC seem to be a safe indicator for discharge after abdominal operations.


     

    Publication History

    Article published online:
    28 August 2023

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