Optimising recovery after surgery: Predictors of early discharge and hospital readmission

Optimising recovery after surgery: Predictors of early discharge and hospital readmission

Carter J, Philip S, Wan KM. Optimising recovery after surgery: Predictors of early discharge and hospital readmission. Aust NZ J Obstet Gynaecol. 2016 Oct;56(5):489-495.

What is already known:

ERAS programmes have been consistently shown to reduce length of stay and post-operative complications. Minimally invasive surgery has largely become the gold standard, but laparotomies are still the mainstay in certain gynaecological cases. This large audit of 550 patients conducted over 7 years comprised all laparotomies for suspected or confirmed gynaecological malignancy in a single centre in Australia.

What this paper adds:

Since the introduction of their fast track surgery (FTS) programme they have shown an overall reduction in adverse events. Ultra-early discharges (on or before day 2) tended to be younger, have benign pathology, performance status 0 and a transverse incision. They report that factors associated with delayed discharge beyond day 3 were age, pathology, performance status, incision type, operating time, blood transfusion and COX-2 inhibitors. Unsurprisingly hospital readmissions were associated with longer operating times, lymph node sampling, longer length of stay, wound infections, febrile morbidity, returns to theatre, unplanned ICU admissions and presence of other complications. Their full ERAS protocol was not published.

This paper highlights that despite adherence to an ERAS protocol, the unmodifiable factors of baseline demographics and disease severity have a significant impact on length of stay and adverse events. ERAS protocols should therefore be encouraged in benign gynaecological laparotomies.

Katie Wimble, Guildford. @wimble_katie