According to new research, the nationwide movement towards shorter hospital stays following surgeries may well be accompanied by an increase in the number of problems that arise after individuals depart the clinic.
Well, at the American College of Surgeons (ACS), researchers reported results from one of the only investigations to look into the connection among the length of stay (LOS) with post-discharge problems for surgical patients.
Shorter Hospitalization Raises The Risk Of Postoperative Complications
“There is a black hole that needs to be addressed between the time the patient gets discharged from the hospital to their first postoperative visit,” Dr. Li said.
“Currently, we are using a wait-and-see model where, as health care providers, we are waiting for surgical patients to approach us with any concerning signs and symptoms.”
Usually, patients are seen impatient to be at home and hence keep on asking about discharge. The trouble starts when they don’t go for further checkups even after having some symptoms or complications, which can spoil the case and lead to more health issues with every passing day.
People may not even be aware of potential problems.
“A shortcoming that emerges from this approach is that patients and their family caregivers often do not recognize early symptoms of complications, and then their problems may worsen, the study’s principal investigator,” Ryan P. Merkow, MD, MS, FACS, assistant professor of surgery at Northwestern Medicine, said.
“I’ve found that many patients and their families are unprepared for the transition from hospital to home and the task of self-care,” Dr. Merkow said. “The surgical team may not find out about a complication until the patient goes to the emergency room or comes for a clinic visit. If we had known earlier, we could have intervened and decreased the severity of the complication or even possibly have prevented it.”
Problems upon release are on the increase.
By using ACS National Surgical Quality Improvement Program (NSQIP) database, the researchers looked into the link between LOS and post-discharge problems. The National Surgical Quality Improvement Program (NSQIP) is the foremost internationally verified, risk-adjusted result in the program for measuring and improving the performance of operational care in hospitals, intending to minimize avoidable postoperative problems.
Wound illnesses, as well as other illnesses like bronchitis, bacterial infection, or circulatory diseases such as sepsis, as per Dr. Li, had much-increased incidence over the duration. Other consequences that escalated as the LOS dropped included cardiac events, cardiogenic shock, or strokes, as well as venous thromboembolism, a dangerous blood clot. Most of those problems are theoretically avoidable; for instance, recognizing & treating a shallow wound soon can avoid issues like operative wound reopening and/or infection.
The following health issues are linked to an increased incidence of post-discharge health problems:
- Individual characteristics include being Hispanic or of “other ethnicity/race,” having a higher BMI, having a larger American Society of Anaesthetists grade loss of independent function, having a greater injury class (a more severe wound), and having had an inpatient problem.
- Variables affecting the process: the length of the surgery and the kind of surgery.
Suggestions
“It’s crucial not to overlook this key period following the patient’s discharge from the hospital,” Dr. Li stated.
According to Dr. Merkow, every institution should have a unified strategy in place to effectively detect and treat post-discharge issues. He suggested that these systems contain the following elements:
- Pre-operative and postoperative training for sufferers and their families to prepare people to notice problematic indications and sensations they must address with their doctor.
- The sufferer and the medical crew can communicate easily.
- Intense surveillance for people who are at a higher danger of problems.
