Delayed discharge after major surgical procedures in Ontario, Canada: a population-based cohort study

Optimizing discharge after major surgery using an artificial intelligence–based decision support tool (DESIRE): An external validation study

“…6,7 However, unnecessary prolonged stays after major surgery are still a common problem and pose a challenge to capacity management due to the restricted number of hospital beds. 5 Over the years, several ML models have been developed to predict adverse postoperative outcomes such as sepsis, mortality, or unplanned readmissions. 35e38 Such models have high predictive value, are useful during the preoperative consent procedure, and improve patients' satisfaction.…”

“…3,4 Thus, the decision for a timely and safe time of discharge is key. 5 Despite initiatives to expedite postoperative recovery such as the Enhanced Recovery After Surgery pathways and the coordinated efforts of physicians, nurses, and policy makers, there is still room for improvement. 6,7 Clinical artificial intelligence (AI) or machine learning (ML)e based prediction models are increasingly reported in medicine and have the potential to improve patient care as well as the surgeon workflow.…”

Delayed discharge and frailty, delirium and functional decline

“…We commend Jerath and colleagues on their recent article, particularly for their robust methodology, but were disappointed that they did not address the concepts of frailty, iatrogenic delirium and functional decline. 1 The lack of adequate data on the concepts of frailty and geriatric syndromes in our acute care national data repositories highlights the existence of major gaps in Canada's health information infrastructure. First, the lack of meaningful data on frailty, delirium and functional decline reduces these key concepts to "nonmedical reasons" for delayed discharge.…”

“…We commend Jerath and colleagues on their recent article, particularly for their robust methodology, but were disappointed that they did not address the concepts of frailty, iatrogenic delirium and functional decline. 1 …”

The authors respond to: “Delayed discharge and frailty, delirium and functional decline”

“…Our study provided the first high-level assessment of the use of alternate level of care in complex surgical patients. 5 Like any early evaluation, we focused on global epidemiological features such as incidence, trends and predictors rather than targeted areas like frailty. Given that we showed that older adults are at greater risk of alternate level of care, next steps in this line of research includes evaluating why they are at higher risk — with frailty being an important potential explanation.…”