A Single-Institution Analysis of Targeted Colorectal Surgery Enhanced Recovery Pathway Strategies That Decrease Readmissions

Stapler, Stevie-Jay; Brockhaus, Kara; Battaglia, Michael A; Mahoney, Stephen T.; McClure, Amanda M; Cleary, Robert K.

doi:10.1097/dcr.0000000000002129

Cited by 11 publications

(17 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[7][8][9][10][11] We previously showed that a readmission intervention bundle including updated preadmission education, a mobile phone application, a pharmacist-led pain management plan, and an early postdischarge clinic significantly decreased emergency department (ED) visits and readmissions after colorectal surgery. 12 However, there was no significant difference in these outcomes for patients with AKI, most of whom were patients who underwent new ileostomies. Difficulty monitoring ileostomy output, nonadherence to antimotility algorithms, lack of assistance managing the ileostomy, barriers to home intravenous (IV) fluids, and home health care nursing limitations are some of the possible contributions to dehydration/AKI and readmissions in this population of patients.…”

Section: Principales Medidas De Resultadomentioning

confidence: 93%

“…13,14 We previously showed that ERP revisions that include a mobile phone application, a pharmacist-led pain management plan, and an early postdischarge clinic visit within 4 to 7 days after discharge decrease readmissions after colorectal surgery. 12 However, the time to readmission for the ileostomy patient population was extended from within 1 week to 2 weeks without decreasing the readmission rate, thereby identifying an opportunity for new ERP quality improvement interventions. The results of this study justify the ERP resource investment focused on improving outcomes for patients after colorectal surgery with new ileostomies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative Oral Rehydration and Regimented Follow-up Decrease Readmissions for Colorectal Surgery Patients with Ileostomies

Westfall,

Rivard,

Suwanabol

et al. 2023

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Ileostomies constitute 15-43% of readmissions after colorectal surgery, often due to dehydration and acute kidney injury. Prior institutional interventions decreased readmissions but not among patients with new ileostomies. OBJECTIVE: Evaluate readmissions among patients with new ileostomies following postoperative oral rehydration solution and standardized clinic visits. DESIGN: Retrospective analysis of prospective database. SETTINGS: Enhanced recovery colorectal surgery service. PATIENTS: New ileostomy patients before and after intervention. INTERVENTION(S): Postoperative oral rehydration solution and postdischarge clinic visits with review of inputs/outputs, antimotility and appliance needs, and trained nurse re-education 4-7 days after discharge, 30-days postoperatively, and every 1-2 weeks thereafter as needed. MAIN OUTCOME MEASURES: Readmission rate due to dehydration/acute kidney injury (primary), emergency department and readmission rates overall and for specific diagnoses. Analysis used univariate and weighted techniques. RESULTS: A total of 312 patients (199 pre-intervention; 113 post-intervention) were included, with a mean age of 59.0 years. Patients were predominantly white (94.9%) and evenly split between men and women. Most common diagnosis was diverticulitis (43.3%). Most common procedure was high anterior resection (38.8%) followed by low anterior resection (16.35%). Patient and procedure characteristics were well matched between groups. Multivariate analysis demonstrated that readmission rate due to dehydration/acute kidney injury significantly decreased between pre- and post-intervention study groups (45.7% vs 16.5%, p = 0.039). ED visits due to dehydration/acute kidney injury (12.0% vs 1.7%, p < 0.001) and readmissions from all causes (24.33% vs 10.6%, p = 0.005) also significantly decreased. Other complications were not significantly different between groups. Average stoma output 24-hours before (776 mL vs 625 mL, p = 0.005) and after (993 mL vs 890 mL, p = 0.025) discharge was significantly decreased in the post-intervention group. LIMITATIONS: Retrospective single center study. CONCLUSIONS: An oral rehydration solution and frequent standardized post-discharge visits led by trained nursing staff decreased readmissions and emergency department visits among patients with new ileostomies following colorectal surgery.

show abstract

Section: Principales Medidas De Resultadomentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Postoperative Oral Rehydration and Regimented Follow-up Decrease Readmissions for Colorectal Surgery Patients with Ileostomies

Westfall,

Rivard,

Suwanabol

et al. 2023

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

show abstract

“…Seven RCTs and 6 nonrandomized cohort studies reported appropriate data on ED visits (Figure 4). The pooled estimate for all studies revealed a decrease in the number of ED visits in the telemedicine group (RR, 0.78; 95% CI, 0.65-0.94). This result showed moderate heterogeneity ( I 2 = 46%).…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, retrospective design and large samples of observational studies have ecological validity and provide additional information on how different technologies and settings may affect the outcomes. In addition, some nonrandomized studies have an appropriate prospective design, sufficient power, and adjustments for several potential sources of bias . Second, it was not possible to identify the specific mechanisms of action underlying the observed differences between telemedicine and conventional care groups; however, this study provided some indications of specific mechanisms that may inform future research.…”

Section: Discussionmentioning

confidence: 99%

Digital Health Interventions and Patient Safety in Abdominal Surgery

Grygorian,

Montano,

Shojaa

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceOver the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these telemedicine interventions are associated with improved patient safety outcomes has not been assessed in systematic and meta-analytic reviews.ObjectiveTo estimate the implications of telemedicine interventions for complication and readmission rates in a population of patients with abdominal surgery.Data SourcesPubMed, Cochrane Library, and Web of Science databases were queried to identify relevant randomized clinical trials (RCTs) and nonrandomized studies published from inception through February 2023 that compared perioperative telemedicine interventions with conventional care and reported at least 1 patient safety outcome.Study SelectionTwo reviewers independently screened the titles and abstracts to exclude irrelevant studies as well as assessed the full-text articles for eligibility. After exclusions, 11 RCTs and 8 cohort studies were included in the systematic review and meta-analysis and 7 were included in the narrative review.Data Extraction and SynthesisData were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline and assessed for risk of bias by 2 reviewers. Meta-analytic estimates were obtained in random-effects models.Main Outcomes and MeasuresNumber of complications, emergency department (ED) visits, and readmissions.ResultsA total of 19 studies (11 RCTs and 8 cohort studies) with 10 536 patients were included. The pooled risk ratio (RR) estimates associated with ED visits (RR, 0.78; 95% CI, 0.65-0.94) and readmissions (RR, 0.67; 95% CI, 0.58-0.78) favored the telemedicine group. There was no significant difference in the risk of complications between patients in the telemedicine and conventional care groups (RR, 1.05; 95% CI, 0.77-1.43).Conclusions and RelevanceFindings of this systematic review and meta-analysis suggest that perioperative telehealth interventions are associated with reduced risk of readmissions and ED visits after abdominal surgery. However, the mechanisms of action for specific types of abdominal surgery are still largely unknown and warrant further research.

show abstract

“…Enhanced recovery pathways (ERPs) and minimally invasive surgical approaches have contributed to improved outcomes and decreased hospital length of stay (LOS) after colorectal surgery. 1 Robotic colectomy patients are now frequently discharged on postoperative day 1 or 2 and this has led to reports suggesting feasibility of same-day discharge. [2][3][4][5][6][7] Discharge on the same day after surgery has not yet been widely adopted and the benefit when compared to an overnight hospital stay is still under investigation.…”

Section: Introductionmentioning

confidence: 99%

Early Discharge after Enhanced Recovery Colectomy Does Not Increase Emergency Department Visits and Readmissions: A Single Institution Analysis

Baur,

Sood,

Huebner

et al. 2024

The American Surgeon™

Self Cite

View full text Add to dashboard Cite

Background Same-day discharge after colorectal surgery in enhanced recovery pathways is increasing. This study aimed to determine if discharge on postoperative days (POD) one or two is associated with increased rates of emergency department (ED) visits and hospital readmissions after left and right colectomy. Methods Single institution retrospective analysis of prospective institutional colorectal surgery database between 07/01/2018 and 07/15/2022. Primary outcomes were ED visit and readmission rates for enhanced recovery open and minimally invasive right and left colectomy using logistic regressions models. Results 820 patients met inclusion criteria. There were significant differences in discharge-day by diagnosis—58.5% of patients with Crohn’s disease were discharged on POD ≥4 and 21.6% with benign colon neoplasia were discharged on POD-0-1 ( P < .001). ED visits occurred in 12.9% of the study population and were not significantly different between discharge-day groups ( P = .096). Overall readmission rate was 8.5% and significantly different between discharge-day groups (0% POD-0 vs 8.3% POD-1 vs 5.8% POD-2 vs 6.9% POD-3 vs 12.9% POD ≥4, P = .041). Logistic regression showed that ED visits and readmissions for longer discharge-days (POD-2, POD-3, POD ≥4) were not significantly different than POD-0-1. Readmission diagnoses for the study population were higher for ileus (17.1%) and surgical site infection (SSI) type-III (22.9%) than for acute kidney injury (1.4%) and SSI type-I/II (1.4%). Conclusion Early discharge after left and right colectomy is not associated with increased rates of ED visits and readmissions. Same-day discharge may be feasible in selected enhanced recovery patients. Standardized post-discharge resources that safely allow same-day discharge require further investigation.

show abstract

A Single-Institution Analysis of Targeted Colorectal Surgery Enhanced Recovery Pathway Strategies That Decrease Readmissions

Cited by 11 publications

References 37 publications

Postoperative Oral Rehydration and Regimented Follow-up Decrease Readmissions for Colorectal Surgery Patients with Ileostomies

Postoperative Oral Rehydration and Regimented Follow-up Decrease Readmissions for Colorectal Surgery Patients with Ileostomies

Digital Health Interventions and Patient Safety in Abdominal Surgery

Early Discharge after Enhanced Recovery Colectomy Does Not Increase Emergency Department Visits and Readmissions: A Single Institution Analysis

Contact Info

Product

Resources

About