Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA.
Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Surg Endosc. 2019 Nov;33(11):3816-3827. doi: 10.1007/s00464-019-06725-x. Epub 2019 Mar 11.
Enhanced Recovery After Surgery (ERAS) programs aim to standardize perioperative care to reduce morbidity and cost. Our study examined an Active Post-Discharge Surveillance (APDS) program in reducing avoidable readmissions and emergency department (ED) visits in postoperative colorectal ERAS patients.
Colectomy (right, subtotal and total) and low anterior resection cases performed at a tertiary care hospital between 2015 and 2018 were reviewed. ED visits, 30-day readmissions, and patients' APDS participation were assessed. Our APDS followed a modern text messaging paradigm offered to all patients free-of-charge.
Of 236 patients that underwent colectomy, 123 utilized APDS and 113 did not. Overall, both non-surveillance (NS) and active surveillance (AS) groups had similar preoperative characteristics. Length of hospital stay at index surgery was longer in the NS compared to AS group, 4.7 ± 2.6 vs. 2.6 ± 2.8 days, respectively (p < 0.001). In the NS group, 16 patients visited the ED, of which 14 (14/16, 87.5%) were ultimately readmitted. One patient was directly readmitted from the surgeon's office, resulting in a total of 15 (15/113, 13.3%) total patients readmitted by postoperative day (POD) 30. In the AS group, 9 patients visited the ED, of which 7 (7/9, 77.8%) were ultimately readmitted. One patient was directly readmitted, resulting in a total of 8 (8/123, 6.5%) total patients readmitted by POD 30. AS patients had significantly lower odds of visiting the ED when compared to NS patients (OR: 0.356; 95% CI: 0.138-0.919; p = 0.0328). Similarly, AS patients had significantly lower odds of readmission when compared to NS patients (OR: 0.343; 95% CI: 0.132-0.892; p = 0.0283).
APDS allows many postoperative issues to be resolved in outpatient settings without ER visits or readmission. This indicates APDS is a valuable ERAS adjunct by establishing a cost-effective and convenient communication line between patients and their surgical team.
加速康复外科（ERAS）方案旨在规范围手术期护理，以降低发病率和成本。我们的研究检查了主动出院后监测（APDS）方案，以减少结直肠 ERAS 术后患者的可避免再入院和急诊就诊。
回顾了 2015 年至 2018 年在一家三级护理医院进行的右半结肠切除术、次全结肠切除术和低位前切除术。评估了急诊就诊、30 天再入院和患者的 APDS 参与情况。我们的 APDS 遵循一种现代的短信模式，免费提供给所有患者。
在接受结直肠切除术的 236 名患者中，有 123 名患者使用了 APDS，113 名患者未使用。总体而言，非监测（NS）和主动监测（AS）组的术前特征相似。NS 组的住院时间明显长于 AS 组，分别为 4.7±2.6 天和 2.6±2.8 天（p<0.001）。在 NS 组中，16 名患者就诊于急诊，其中 14 名（14/16，87.5%）最终再次入院。一名患者直接从外科医生办公室再次入院，导致共有 15 名（15/113，13.3%）患者在术后第 30 天再次入院。在 AS 组中，9 名患者就诊于急诊，其中 7 名（7/9，77.8%）最终再次入院。一名患者直接再次入院，导致共有 8 名（8/123，6.5%）患者在术后第 30 天再次入院。与 NS 组相比，AS 组患者就诊于急诊的可能性显著降低（OR：0.356；95%CI：0.138-0.919；p=0.0328）。同样，与 NS 组相比，AS 组患者再次入院的可能性显著降低（OR：0.343；95%CI：0.132-0.892；p=0.0283）。
APDS 允许许多术后问题在门诊环境中得到解决，而无需急诊就诊或再次入院。这表明 APDS 通过在患者及其外科团队之间建立一条具有成本效益和便利的沟通渠道，是一种有价值的 ERAS 辅助手段。
