title: Prospective Evaluation of Discharge Trends after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) pathways proved to reduce complications, length of hospital stay and costs after colorectal surgery. Standardized discharge criteria have been established that are fulfilled after complete medical recovery is achieved. This study aimed to assess the timing of complete medical recovery in relation to the timing of actual discharge, and to assess reasons for prolonged hospital stay within an ERAS pathway.
  
  
  METHODS
  One hundred fourteen consecutive patients undergoing elective colorectal surgery within an ERAS pathway were included in this prospective analysis. Fulfillment of discharge criteria was assessed daily and reasons for prolonged hospital stay were documented.
  
  
  RESULTS
  Thirty percent of patients went home on the day that all discharge criteria were met. Overall, patients were discharged at a median of 2 days (interquartile range 1-3) after fulfillment of discharge criteria. Reasons for delayed discharge were (1) organizational in 20%; (2) patient or surgeon unwilling in 29%; and (3) because the patient was deemed to be discharged too soon distance from the operation in 51%.
  
  
  CONCLUSIONS
  In this observational study, only 30% of patients were discharged on the day all recovery criteria were met. The main reason for continued hospitalization was surgeon- or patient-related reluctance or 'precaution'; thus, better and more of general information seems to be necessary.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Juliette C
authors.initials: JC
authors.lastname: Slieker
authors.forename: Daniel
authors.initials: D
authors.lastname: Clerc
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D003082:Colectomy; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010342:Patient Acceptance of Health Care; D010351:Patient Discharge / Q000639:trends*; D011182:Postoperative Care; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*
keywords: Colorectal surgery; Discharge; Enhanced recovery after surgery; Postoperative recovery