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Criteria-led discharge identifies opportunities to shorten hospitalization after elective open abdominal wall
Samantha W Kerr1, Sullivan A Ayuso2, Danette Denham3
1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Introduction:
Length-of-stay (LOS) following abdominal wall reconstruction (AWR) varies widely and may be influenced by subjective discharge practices. Criteria-led discharge (CLD) protocols have reduced LOS in other surgical populations but have not been established for AWR. This observational study aimed to develop CLD for open AWR.
Methods:
Elective open AWR patients (2022-2025) were prospectively consented under IRB approval. Charts were reviewed using the CLD, based on clinical assessment, laboratory values, and surgeon evaluation. The primary outcome was LOS at criteria fulfillment.
Results:
Fifty patients were included. Average LOS was 3.9 ± 2.2 days versus 3.4 ± 2.4 days in the CLD model (p < 0.001). Thirty-eight percent remained hospitalized beyond criteria clearance, most commonly awaiting bowel function or diet tolerance. This subgroup had longer LOS (3.5 ± 1.1vs2.3 ± 1.1 days; average difference 1.3 ± 0.45;p < 0.001). Thirty-day events included two ICU admissions, two 30-day readmissions, and one reoperation.
Conclusions:
CLD after AWR is feasible and may safely reduce LOS, supporting prospective implementation studies.
