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Earlier discharge after surgery may come at the expense of post-discharge complications


NEW YORK (Reuters) – The trend toward shorter hospital stays after surgical procedures may come at the expense of an increase in post-discharge complications, according to research presented at the American College of Surgeons (ACS) Clinical Congress.

Using an ACS database, researchers evaluated data from 2014 to 2019 for more than 538,000 patients who underwent any of 11 surgical procedures of the colon and rectum; the esophagus; the hepatopancreatobiliary system; or the gynecologic or urologic systems.

During the five-year study period, the medium length of hospital stay following surgery fell by one day (from three to two days), while post-discharge complications (occurring from the day of discharge up to 30 days) increased by 12%. In addition, the proportion of post-discharge complications rose from 44.6% to 56.5%.

Multiple serious complications, including infections and cardiac problems, occurred at significantly higher rates after discharge in 2019, when the average hospital stay was shorter compared with four years earlier, co-investigator Dr. Ruojia Debbie Li, research of Northwestern University Feinberg School of Medicine, in Chicago, told attendees.

“Our ultimate takeaway message is that there is a black hole that needs to be addressed between the time a patient gets discharged from the hospital to their first post-operative visit,” Dr. Li said.

Patient factors associated with higher likelihood of post-discharge complications included Hispanic or other ethnicity/race, higher body weight, higher American Society of Anesthesiologists class (a surrogate for general health status used to predict operative risk), loss of independent function, higher wound class (a more severe wound) and experiencing an inpatient complication. Procedural factors included longer duration of operation and the type of operation.

The team also says hospitals need a coordinated system that takes risk factors for post-discharge factors into account to better identify and manage post-discharge complications.

Principal investigator Dr. Ryan Merkow of Northwestern Medicine told attendees the findings “point to the need to educate patients and their families prior to surgery and before they are discharged from the hospital in order to equip them with the skills and self-management ability to recognize concerning signs and symptoms that should be discussed with their surgeon or surgical team.”

The study had no specific funding and the authors have no relevant disclosures.

Reuters Health Information © 2021

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