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International Journal of Colorectal Disease

, Volume 34, Issue 11, pp 1865–1870 | Cite as

ERAS, length of stay and private insurance: a retrospective study

  • Diana A. CelioEmail author
  • Roberto Poggi
  • Mike Schmalzbauer
  • Raffaele Rosso
  • Pietro Majno
  • Dimitri Christoforidis
Original Article
  • 51 Downloads

Abstract

Purpose

Hospital discharge after colorectal resection within an Enhanced Recovery After Surgery (ERAS) program occurs earlier compared to standard-care postoperative pathways but often later than what objective criteria of “readiness for discharge” could allow. The aim of this study was to analyse reasons and risk factors of such discharge delay.

Methods

All elective patients admitted for colorectal resection at the regional Hospital of Lugano in 2014 and 2015 were included. The postoperative day on which patients fulfilled consensus agreed criteria (according to Fiore) for readiness for discharge (POD-F) and the effective day of discharge (POD-D) were determined. We analysed the reasons for discharge delay (POD-D>POD-F) and performed univariate and multivariate analysis to determine risk factors.

Results

One hundred thirty-eight patients were included in the study. Median POD-F was 5 (2–48) days, POD-D was 6 (3–50) days. In 94 patients, POD-D occurred later than POD-F with a median delay of 1 (1–11) days. Reasons for discharge delay were insufficient social support in 13 (14%), patient’s preference in 39 (41%) and medical team preference in 41 (44%). 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.

Conclusion

Even when objective criteria for readiness for discharge have been fulfilled, patients and/or doctors often do not feel comfortable with hospital discharge at this time point. Length of stay, even within an ERAS program, is still influenced by several non-medical factors and is therefore not a precise surrogate marker of outcomes.

Keywords

ERAS Length of stay Time to readiness for discharge Discharge delay Healthcare insurance 

Notes

Acknowledgements

The authors would like to thank Esther De Krujif for the statistical analysis of the data.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of Ticino (2019–00941 /CE 3482) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

In accordance with the ethics committee of Ticino, Switzerland, an individual informed consent of all participants was not considered necessary.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Ospedale Regionale di LocarnoLocarnoSwitzerland
  2. 2.Department of AnaesthesiologyRegional Hospital of LuganoLuganoSwitzerland
  3. 3.Regional Hospital of LuganoLuganoSwitzerland
  4. 4.Department of SurgeryRegional Hospital of LuganoLuganoSwitzerland

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