|
Back to 2017 Program and Abstracts
EMERGENCY ROOM VISITS AND READMISSIONS FOLLOWING IMPLEMENTATION OF AN ENHANCED RECOVERY AFTER SURGERY (ERAS) PROGRAM
Trevor Wood*1, Mary-Anne Aarts1, Allan Okrainec1, Emily A. Pearsall1, J Charles Victor2, Marg McKenzie1, Ori Rotstein1, Robin McLeod1
1Surgery, University of Toronto, Toronto, ON, Canada; 2University of Toronto, Toronto, ON, Canada
Background: Enhanced Recovery after Surgery (ERAS) guidelines have been widely promoted and supported largely due to several studies showing decreased postoperative complications and length of stay. However, there are concerns that shorter hospital stays may lead to increased emergency room visits or readmissions. The objective of this study was to review the ER visits and readmission rates and reasons for both in patients following an ERAS guideline.
Methods: All patients having elective colorectal surgery at 15 academic hospitals were enrolled in a government-supported ERAS implementation program. All patients were followed until 30 days post-discharge. Demographic and outcome data were collected prospectively. Data was analyzed using descriptive statistics and multivariate analysis.
Results: Between September 2012 and April 2015, 2,876 patients (48% female; mean 60 years old) were enrolled. Cancer was the most frequent indication (68.2%) for surgery; 52.9% procedures were performed laparoscopically and 27.1% of procedures were rectal. Overall the mean LOS was 6.9 days. In total, 359 (11.6%) of patients were seen in the ER post discharge. The most common reasons for visiting the ER were SSI (34.5%), other wound complications (10.0%) and UTI (8.6%). In total, 260 (8.2%) patients were readmitted to hospital. The most common reasons for readmission were nausea and vomiting (26.2%), intra-abdominal infection (23.9%), and SSI (11.5%). On multivariate analysis, shorter LOS (1.03, 95%CI 1.02-1.05) and rectal procedure ( 1.52, 95%CI 1.28-1.79) were associated with ER visits while shorter LOS (1.06, 95%CI 1.04-1.09), rectal procedure (2.04, 95% CI 1.45-2.86), reoperation (5.52, 95% CI 4.09-7.44) and presence of a stoma (1.39, 95% CI 1.07-1.82) were associated with readmission.
Conclusion: Approximately 10% of patients visit the ER or are readmitted following discharge after colorectal surgery. The most common reasons are wound complications and nausea and vomiting. Furthermore, individuals having a rectal procedure, who have a stoma or a reoperation appear to be the highest at risk groups. In an effort to decrease readmissions and ER visits, guidelines are currently being developed on prevention of SSIs, management of patients with a stoma within an ERAS program as well as post-discharge management of wounds. Lastly, providing information to patients on common complications and how to manage after discharge may decrease ER visits and readmissions.
Back to 2017 Program and Abstracts
|
