Portal de Periódicos da CAPES

ERAS, hospital stay and private insurance

2016; Elsevier BV; Volume: 12; Linguagem: Inglês

10.1016/j.clnesp.2016.02.014

2405-4577

Diana Celio, Esther De Kruijf, Roberto Poggi, Mike Schmalzbauer, Raffaele Rosso, Dimitri Christoforidis,

Anesthesia and Pain Management

Objectives: Hospital discharge after colorectal resection within an ERAS programme often occurs later than what objective discharge criteria (Fiore1) could allow. After an initial retrospective analysis of our data in 2014, we collected prospectively the Fiore criteria and the reason for discharge delay to sensitise our team to avoid unnecessary hospital stay extension. The aim of this study was to analyse the efficacy of this measure and the risk factors of discharge delay. Methods: All patients admitted electively for colorectal resection at our hospital in 2014 and 2015 were entered in the ERAS database and included in the study. The postoperative day on which patients fulfilled the Fiore criteria1 for readiness to discharge (POD-F) and the effective day of discharge (POD-D) were determined retrospectively (01/2014-06/2015, 107 (78%) patients) and prospectively (07/2015-12/2015, 31 (22%) patients). We analysed the reasons for discharge delay and performed univariate and multivariate analysis to determine risk factors. Results: We included 138 patients (52% female) with a median age of 69 (20-89) years; 33% needed a rectal resection and 66% had malignant disease. Median POD-F was 5 (2-48) days, POD-D was 6 (3-50). In 94 patients POD-D occurred a median of 1 (1-11) days later than POD-F. Reasons for discharge delay were insufficient social support in 13 (14%), patient’s preference in 39 (41%) and medical team preference in 41 (44%). In one patient extended hospitalization was due to a neurosurgical intervention. There was no difference in demographic data, rate, length and reasons for discharge delay between the retrospective and the prospective cohort. Private insurance (OR: 2.61 95%CI 1.08-6.34, p=0.034) and patient discharged on a day other than Monday (OR: 2.94 95%CI: 1.16-7.14, p=0.023) were independent predictors for discharge delay. The reason for discharge delay significantly predicted the length of delay; it was longest for insufficient social support (mean 3.8 days, 95%CI: 1.87-5.67, p<0.001). Conclusion: The introduction of a specific patient diary with objective discharge criteria did not decrease the rate of discharge delay. Private insurance seems to be one of several non-medical factors that prolong hospital stay. Waiting for post-acute care created the longest delays. References: 1. Fiore JF Jr, et al. Dis Colon Rectum 2012;55:416-23 Disclosure of interest: None declared.