A Comparison of Re-admission and Emergency Department Visits in a Colorectal Surgical Home versus Traditional Perioperative Care

Author(s): Caroline A Couch, Kristen L Coleman, Angela N Fellner, Hamza Guend

Purpose: A perioperative surgical home is a program that combines enhanced recovery protocols (ERP) with pre-operative optimization and intra-op protocols to improve outcomes post-operatively. There is no significant research on them in colorectal surgery. Our objective was to study the effect of a surgical home on re-admissions and ED visits of colorectal patients compared to traditional management.

Methods: This was a retrospective study in a single system with multiple hospitals. The study group had elective colorectal surgery resection after the implementation of a colorectal surgical home that provided perioperative optimization. Patients were compared to those who underwent colorectal surgery resection with ERP but before the surgical home was established. Hospital re-admissions and ED visits within 30 days were then compared between the groups.

Results: A total of 167 colorectal surgical home patient charts were compared to colorectal ERP patients only. The surgical home patients were younger than the ERP (61.6 vs 65.4). However, ASA scores and preoperative comorbidities were very similar between the groups. The 30-day re-admissions and ED visits were improved but not statistically significant between the matched groups (10.2% vs 15.0% and 15.6% vs 19.8%) (p = 0.124 and p = 0.195). Secondary outcomes noted the surgical home group did have a lower length of stay and fewer conversions to open.

Conclusions: Although there was no statistical significance between the 30- day re-admissions or ED visits, this trended towards improvement in patient treated under a surgical home when compared to those treated under ERP. ED visits decreased by 1/4 and re-admissions decreased by 1/3.