Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

Eur Surg Res. 2017;58(5-6):263-273. doi: 10.1159/000479004. Epub 2017 Aug 9.

Abstract

Background: To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model.

Methods: A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged.

Results: A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42.

Conclusions: For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.

Keywords: Efficiency; Enhanced recovery after surgery; Hospital-at-home; Laparoscopic colorectal surgery; Safety.

MeSH terms

  • Adult
  • Aged
  • Colorectal Surgery / rehabilitation*
  • Female
  • Home Care Services, Hospital-Based / economics*
  • Humans
  • Laparoscopy / rehabilitation*
  • Male
  • Middle Aged
  • Patient Discharge / standards*
  • Postoperative Complications / epidemiology*
  • Prospective Studies
  • Spain / epidemiology