Ensuring a swift discharge after surgery is important for patient outcomes and helps reduce health care costs 1. A number of factors can influence time to discharge following surgery, ranging from anesthesia to perioperative workflow.
First, even after controlling for other clinically important factors, anesthetic management during surgery can affect postoperative length of stay.
A U.S.-based 2015 study probed the impact of regional versus general anesthesia on the length of time between leaving the operating room and hospital discharge, in addition to the odds of in-hospital mortality. Their analyses demonstrated that the median time to hospital discharge among patients who received regional anesthesia was 68 hours, in contrast to 72 hours among patients who received general anesthesia 2. Additionally, regional anesthesia use during surgery was associated with a decrease in in-hospital mortality.
A French 2022 study searched for factors associated with a prolonged discharge time after surgery in over 500 patients. First, their analysis revealed that using ketamine increased time to discharge. Specifically, the anesthesia-related factor independently associated with prolonged discharge time primarily consisted of the dose-weight of ketamine, in interaction with the dose weight of sufentanil. Second, their analyses further revealed that the use of non-steroidal anti-inflammatory drugs (NSAIDs), in contrast, shortened hospital discharge time 3. However, this study was carried out in an ambulatory surgery setting and remains to be confirmed across a variety of surgical settings.
When properly implemented, clinical pathways that improve patient flow can help improve patient care and patient throughput. An American research team in 2020 sought to pinpoint ways in which the use of electronic medical records could improve patient discharge times. Their data highlighted a few key areas related to better communication across providers, including the identification of potential early discharge patients, the prioritization of such early discharges where feasible, the use of a patient flow nurse, lucid communication across interdisciplinary health care providers, and the implementation of a shared discharge plan 4.
Recently, a 2022 Dutch study studied whether artificial intelligence could streamline clinical decision-making as regards patient discharge. The study specifically demonstrated that a previously developed machine learning concept, trained on local patient data, can be successfully used to predict safe patient discharge. Given its accuracy, incorporating this machine learning tool into the clinical workflow could shorten time to discharge after surgery and help hospitals address capacity challenges by minimizing avoidably long stays 5.
An interesting balance must be struck: rapid discharge can facilitate a swift return to normal daily activities for patients, but a discharge that is too hasty may, conversely, be associated with high readmission and complication rates (especially, for example, following open colorectal surgery).
Effective clinical management pre-discharge ensures that the right balance is struck for maximal patient well-being, to which using standardized postoperative care protocols and discharge criteria is key 6. Post-discharge, close patient monitoring and continued management is also important to prevent negative outcomes. A 2020 study on continued monitoring found that electronic patient-reported outcome systems may support remote, real-time symptom monitoring and detection of complications following discharge, thereby enhancing long-term patient safety and outcomes.
Optimizing time to patient discharge remains a priority in the context of anesthetic management. Research to date suggests that the preferential use of regional anesthesia, NSAIDs, and the avoidance of ketamine decrease time to discharge and may also improve patient outcomes. Additional research remains in order to specify factors across a number of surgical settings and implement effective strategies.
References
1. Reducing Length of Stay Improves Outcomes and Lowers Costs. Available at: https://www.healthcatalyst.com/success_stories/reducing-length-of-stay-memorial-hospital-at-gulfport.
2. Bulka, C. M., Shotwell, M. S., Gupta, R. K., Sandberg, W. S. & Ehrenfeld, J. M. Regional anesthesia, time to hospital discharge, and in-hospital mortality: A propensity score matched analysis. Reg. Anesth. Pain Med. (2014). doi:10.1097/AAP.0000000000000121
3. Picard, L. et al. Risk factors for prolonged time to hospital discharge after ambulatory cholecystectomy under general anaesthesia. A retrospective cohort study. Int. J. Surg. 104, 106706 (2022). doi:10.1016/j.ijsu.2022.106706
4. Younger, S. J. Advanced Practice Provider-Led Strategies to Improve Patient Discharge Timeliness. Nurs. Adm. Q. (2020). doi:10.1097/NAQ.0000000000000435
5. van de Sande, D. et al. Optimizing discharge after major surgery using an artificial intelligence–based decision support tool (DESIRE): An external validation study. Surgery 172, 663–669 (2022). doi:10.1016/j.surg.2022.03.031
6. Delaney, C. P. Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. Dis. Colon Rectum (2008). doi:10.1007/s10350-007-9126-y