Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England
Abstract
Background: 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.
Methods: 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.
Results: 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: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.
Conclusions: 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.
Date
2025-04-22
Type
Article
Subject
Colorectal neoplasms, Colorectal surgery, Elective surgical procedures, Postoperative care
Collections
Citation
Dawes M, Packman Z, McDonald RA, Cheetham MJ, Gallagher-Ball NMT, Warwick E, Oyston M, McCone E, Snowden C, Swart M, Briggs TWR, Gray WK. Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England. Br J Anaesth. 2025 Jun;134(6):1765-1772. doi: 10.1016/j.bja.2025.02.034. Epub 2025 Apr 22.
Journal / Source Title
British Journal of Anaesthesia
DOI
10.1016/j.bja.2025.02.034
PMID
40268639
Publisher
Elsevier
Publisher’s URL
https://www.sciencedirect.com/journal/british-journal-of-anaesthesia