Predicting delayed discharge in a multimodal Enhanced Recovery Pathway.

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Patient Recovery Pathways

Background:

• Enhanced Recovery Pathways (ERP) aim to optimize patient recovery and reduce length of stay (LOS) after surgery.
• Despite ERP implementation, some patients experience unexpectedly prolonged LOS, necessitating identification of associated factors.

Purpose of the Study:

• To identify patient and procedural variables linked to delayed discharge in minimally invasive colorectal resections within an established ERP.
• To understand factors contributing to ERP failure, defined as LOS ≥5 days.

Main Methods:

• A retrospective review of a divisional database for minimally invasive colorectal resections (August 2013 - July 2015).
• Patients were categorized into ERP success (LOS <5 days) or failure (LOS ≥5 days).
• Logistic regression analysis was used to determine variables predicting ERP failure.

Main Results:

• 45 of 274 patients (16.4%) experienced ERP failure.
• Factors associated with ERP failure included preoperative anxiety, chronic pain, prior abdominal surgery, and chemoradiation.
• Intraoperative factors like conversion to open surgery and blood transfusions were significantly higher in the failure group.
• Anxiety (OR 2.28), chronic pain (OR 10.03), and intraoperative conversion (OR 8.02) were independently associated with delayed discharge.

Conclusions:

• Preoperative patient factors (anxiety, chronic pain) and intraoperative procedural factors (conversion) are significantly associated with delayed discharge in colorectal surgery.
• Prospective patient preparation and practice modifications addressing procedural elements and ERP adherence can enhance postoperative outcomes.