EP725 - Reasons for Delayed Hospital Discharge in Medically Ready Patients Following Elective Colorectal Surgery

Purpose/Background: Extended postoperative length of stay (LOS) following elective colorectal surgery increases risk of hospital-acquired infections and deconditioning. Prolonged LOS also results in substantially higher healthcare costs and contributes to inpatient bed shortages. Reasons for delayed discharge among patients who are medically ready are not well established for elective colorectal surgery.

Methods/Interventions: We conducted a prospective observational study at an urban, safety-net hospital. All patients from 12/2024-9/2025 admitted for an elective colorectal surgery with a planned inpatient stay of at least 1 day were included. All operations were performed by colorectal surgeons and patients recovered on a dedicated CRS service, which uses a standard ERAS protocol. All patients received standard counseling on expected post-operative recovery and discharge. Demographic information, patient comorbidities and diagnostic information, surgical approach, length of surgery, and estimated blood loss were collected. The dates patients were medically cleared for discharge and when they were actually discharged were compared. Those discharged the next day or later than when they were medically cleared were considered a late discharge. The clinical team was surveyed to detail reasons for late discharge.

Results/Outcomes: Of the 95 patients included, half were female (53%), the median age was 55 (IQR 47-63.5), 36% were White and 31% were Black. 72% were non-Hispanic. Common reasons for admission included cancer (51%), diverticulitis (17%), and inflammatory bowel disease (12%). Surgical approach was evenly distributed between robotic (38%) and laparoscopic (38%), with a minority of open cases (24%). The most common operations were colectomies and low anterior resections (62%) and ostomy reversals (18%). 19% of patients (n=18) were discharged later than when they were medically cleared. The most common reason for late discharge was patient preference to stay longer (56%). Other reasons included inadequate pain control (11%), transportation issues (11%), absence of an ostomy nurse for education over the weekend (11%), and case management challenges with rehab placement (22%). Late discharge was not associated with age, sex, race, or operative approach in a fisher analysis (p>0.05).

Conclusion/Discussion: This study of patients with extended LOS following elective colorectal surgery identified nuanced social and logistical issues that are not typically documented in electronic medical records. Even with appropriate counseling about postoperative recovery expectations, certain patients remain uncomfortable being discharged when clinicians deem them medically ready. Pressuring such patients to leave the hospital may adversely affect the patient-physician relationship. Additionally, the results of this study should be accounted for while setting reasonable metrics for LOS. Programs like Hospital at Home could serve as a helpful bridge for these select patients.

Reasons for Delaye Discharge
Most common reasons for patients being discharged later than when they were medically cleared for discharge