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The likelihood of postoperative complications after discharge increases with shorter hospital stays

Are you chasing shorter stays at the expense of post-discharge complications? Credit: American College of Surgeons

New research results suggest that the national trend of shorter hospital stays after surgical procedures may come at the expense of an increased rate of complications that occur after a patient is discharged. increase. Findings from one of the few studies investigating the relationship between length of stay (LOS) and post-discharge complications of surgical patients were presented at the American Academy of Surgery (ACS) Virtual Clinical Conference 2021.

Over the past two decades, hospitals have shortened the length of stay for inpatients, partly due to factors such as the emphasis on outpatient care.*, Bed shortages, cost savings, and payer requirements. A new study found that median or median LOS after surgery decreased by a third from 3rd 2014 to 2nd 2019.

Researchers found that the overall rate of postoperative complications was reduced by 1% in a five-year study, but were discharged in some common surgical disciplines of more than 538,000 American patients. We found that post-complications increased by 12%.

Infectious diseases Heart problemsResearch collaborators Ruojia Debbie Li, MD, and MS said the incidence was significantly higher after discharge in 2019, when the average length of stay was shorter than in 2014. Dr. Lee is a researcher at the Feinberg School of Medicine at Northwestern University in Chicago, where the study was conducted.

“There are black holes that need to be addressed between the patient’s discharge and the first postoperative visit,” said Dr. Li. “Currently we are using the wait model. Health provider, We are waiting Surgical patient To approach us about the signs and symptoms. “

Patient may not be aware of complications

The disadvantage of this approach is that patients and their family caregivers are often unaware of the initial symptoms of complications, which can exacerbate the problem. The principal investigator of this study, Ryan P. Melkow, MD, MS, FACS, Associate Professor of Surgery, said in Northwestern Medicine.

“Many patients and their families were found to be unprepared for hospital-to-home migration and self-care work,” said Dr. Merkow. “NS Surgical team You may not be able to know about the complications until the patient goes to the emergency room or visits the clinic. If we knew before, we could have intervened to reduce or prevent the severity of the complications. “

Dr. Merkow said researchers usually count the rate of complications within the first month after surgery. This number is a combination of hospital and post-discharge complications. Therefore, he said, there is little evidence of how shortened hospital stays affect post-discharge complications.

Dr. Ryan P. Melkow, MD, FACS, Assistant Professor of Surgery, Northwestern Medicine, and Dr. Luozia Debbie Lee, MS, Researcher at Northwestern University’s Fineberg School of Medicine will explain the findings. Credit: American College of Surgeons

Increasing complications after discharge

The research team used the ACS National Surgical Quality Improvement Program (NSQIP) database to study the association between LOS and post-discharge complications. NSQIP is a nationally validated, risk-adjusted, results-based primary program for measuring and improving the quality of surgical treatment in hospitals, with the goal of reducing preventable postoperative complications. It is said.

Specifically, the researchers evaluated 2014-2019 data for patients who underwent one of 11 colon and rectal surgeries. Esophagus; hepatopancreatic bile duct system including liver, pancreas, gallbladder and bile ducts; or gynecological or urological system.

Adverse events that occurred on the day of discharge and within 30 days of surgery were considered post-discharge complications, Dr. Li explained. Researchers found that the rate of complications after discharge increased from 44.6% in 2014 to 56.5% five years later.

According to Dr. Li, a significantly higher percentage of complications over time included surgical site infections and other infections such as pneumonia, urinary tract infections, and bloodstream infections known as sepsis. rice field. Other complications that increased as LOS decreased were heart attack, cardiac arrest, or stroke, and a severe thrombosis called venous thromboembolism. Many of these complications are potentially preventable. For example, early recognition and management of superficial wound infections can prevent consequences such as surgical wound opening and / or sepsis.

The risk factors associated with the higher odds of post-discharge complications are:

  • Patient Factors: Hispanic or “Other Ethnicity / Race”; Higher Body Mass Index; Higher American Society of Anesthesia Class (representative of general health condition used to predict surgical risk).Loss of independent function; higher wound class (severe wounds); experiencing complications in inpatients
  • Procedure Factors: Longer Surgery and Types of Surgical Procedures

Recommendations

“It’s important not to ignore this important period after the patient is discharged,” said Dr. Lee.

To reduce the complication rate after discharge, each hospital Dr. Merkow said a coordinated system is needed to better identify and manage these complications. He recommended that such a system include the following components:

  • Education of patients and their families before surgery and discharge. The purpose is to help you recognize the signs and symptoms that you should discuss with your surgeon.
  • Easy communication between the patient and the surgery team
  • More intensive monitoring for patients at high risk of complications

Studies suggest that same-day discharge of hip and knee replacements is safe and feasible for high-risk patients


For more information:
Li RD, et. al. Are you chasing shorter stays at the expense of post-discharge complications? American College of Surgeons Clinical Conference 2021.

Quote: Https: //medicalxpress.com/news/2021-10-chance-postoperative-complications-hospital-charge.html due to shortened hospital stay (October 24, 2021) obtained on October 24, 2021 Increased likelihood of postoperative complications after discharge

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The likelihood of postoperative complications after discharge increases with shorter hospital stays

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