Dawes Mindy, Packman Zoë, McDonald Ruth A, Cheetham Mark J, Gallagher-Ball Nannette M T, Warwick Eleanor, Oyston Maria, McCone Emma, Snowden Chris, Swart Michael, Briggs Tim W R, Gray William K
Getting It Right First Time Programme, NHS England, London, UK; Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Office of the Chief Nurse, NHS England, London, UK.
Office of the Chief Nurse, NHS England, London, UK.
Br J Anaesth. 2025 Jun;134(6):1765-1772. doi: 10.1016/j.bja.2025.02.034. Epub 2025 Apr 22.
Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.
This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.
Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X=24.885, P<0.001; rectal surgery: X=61.670, P<0.001) and was not associated with 30-day emergency readmission.
We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.
强化康复路径（ERP）旨在改善择期手术后的患者预后。我们的主要目的是研究在英格兰，作为ERP替代结局的较短住院时间是否与结肠和直肠手术30天急诊再入院率较高相关。次要目的是评估医院对特定术后护理套餐（24小时内饮水、进食和活动，即DrEaMing）的依从性与结局之间的关系。
这是一项对英格兰医院事件统计数据集的观察性数据进行的回顾性分析。纳入了2014年4月1日至2024年3月31日期间所有年龄≥17岁因癌症接受择期结肠或直肠手术的患者。
在124580例结肠手术患者和87036例直肠手术患者中，较短的住院时间与30天急诊再入院率较低显著相关。比较住院时间的第一个（参考）四分位数和第四个四分位数，结肠和直肠手术30天急诊再入院的几率分别增加了2.16（95%置信区间[CI]2.04 - 2.30）和2.41（95%CI 2.26 - 2.57）。医院对DrEaMing的依从性增加与住院时间延长患者数量的减少相关（结肠手术：X = 24.885，P < 0.001；直肠手术：X = 61.670，P < 0.001），且与30天急诊再入院无关。
我们没有发现证据表明较短的住院时间或更高的DrEaMing依从性与更高的急诊入院率相关。这些发现不应被解释为因果关系。
