CHANGES IN SHORT-TERM POST-DISCHARGE COMPLICATIONS AFTER COLON SURGERY IN THE MODERN ERA: IMPLICATIONS FOR RECOVERY MONITORING?
Ruojia D. Li*2, Rachel H. Joung2,1, Brian C. Brajcich2,1, Karl Bilimoria2,1, Ryan P. Merkow2,1
1Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Northwestern University Surgical Outcomes & Quality Improvement Center, Chicago, IL
Introduction:
Colon resection is associated with an appreciable risk of short-term postoperative complications, many of which occur after patients are discharged from the hospital. With widespread adoption of enhanced recovery protocols, and a push toward shorter length of stay (LOS) by hospitals and payers, the extent to which complications have shifted to the post-discharge setting is unknown. The objectives of this study were to (1) characterize changes in LOS and post-discharge complications over time, and (2) evaluate risk factors associated with post-discharge complications.
Methods:
Patients who underwent elective colon resection from 2012 to 2018 were identified from the ACS NSQIP Colectomy-targeted Dataset. The outcomes assessed included LOS and 30-day complications. Changes in proportion of post-discharge complications were evaluated over time, and predictors of post-discharge complications were assessed using multivariable logistic regression.
Results:
Of the 98,897 patients who underwent colon resection during the study period, the median LOS decreased from 5 days in 2012 to 4 days in 2018. The overall 30-day complication rate was 22.0%, which decreased during the study period (26.5% to 19.6%, p<0.001). Of the 13 individual complications evaluated, 8 demonstrated a significant increase in the proportion of post-discharge events from 2012 to 2018 including overall SSI (53.1% to 64.8%, p<0.001), superficial SSI (56.7% to 75.9%, p<0.001), deep/organ space SSI (44.4% to 57.5%, p=0.002), unplanned intubation (13.8% to 33.8%, p<0.001), pneumonia (20.0% to 33.0%, p<0.001), venous thromboembolism (VTE) (46.0% to 60.3%, p=0.03), UTI (38.9% to 63.4%, p<0.001), and sepsis (29.3% to 46.3%, p<0.001). Multivariable analysis demonstrated patients were more likely to develop any post-discharge complication if male (OR 1.28, 95% CI 1.18-1.38), >75 years old (OR 1.28, 95% CI 1.02-1.61), Black (OR 1.57, 95% CI 1.37-1.80) or other race (1.44, 95% CI 1.29-1.61) vs. White, ASA III/IV/V (OR 1.16, 95% CI 1.06-1.27) vs. ASA I/II, and dependent functional status (OR 1.41, 95% CI 1.14-1.75) vs. independent. Intraoperative factors associated with increased odds for developing any post-discharge complication included wound class III/IV (OR 1.52, 95% CI 1.38-1.67) vs. I/II, operation time (4-6h: OR 1.20, 95% CI 1.06-1.36; >6h: OR 1.61, 95% CI 1.36-1.90) vs. <2h, and open (OR 1.31, 95% CI 1.20-1.42) vs. minimally invasive approach.
Conclusions:
Although LOS and 30-day complications decreased over time, the proportion of events occurring post-discharge increased for 8 of 13 complications. Patient monitoring programs focused on early identification and management of post-discharge complications should be developed.
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