ERAS, length of stay and private insurance: a retrospective study
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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.
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.
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.
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.
KeywordsERAS Length of stay Time to readiness for discharge Discharge delay Healthcare insurance
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.
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.
In accordance with the ethics committee of Ticino, Switzerland, an individual informed consent of all participants was not considered necessary.
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