EP723 - Implementation of a Patient Education Protocol to Reduce Length of Hospital Stay after Colon and Rectal Surgery

ePoster Presenter(s)

• MD

  Megan Duellman, RN

  Registered Nurse
  University of Minnesota
  University of Minnesota
  Minneapolis, MN, United States

  Disclosure information not submitted.

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Author(s)

• 

  Julia Frebault, MD (she/her/hers)

  General Surgery Research Resident
  University of Minnesota
  University of Minnesota
  Minneapolis, MN, United States

  Disclosure information not submitted.
• SL

  Scott Lunos, MS

  Senior Biostatistician
  University of Minnesota
  Minneapolis, Minnesota, United States

  Disclosure information not submitted.
• DK

  Dina Khaled, DNP, APRN, CNP

  Assistant Professor
  Metro State University
  Saint Paul, Minnesota, United States

  Disclosure information not submitted.
• HN

  Harika Nalluri-Butz, MD

  Assistant Professor
  University of Minnesota
  Minneapolis, Minnesota, United States

  Disclosure information not submitted.
• EA

  Elliot G. Arsoniadis, MD, PhD

  Assistant Professor of Surgery
  University of Minnesota
  Minneapolis, Minnesota, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
• 

  Cyrus Jahansouz, MD

  Assistant Professor
  University of Minnesota
  University of Minnesota
  Minneapolis, Minnesota, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• GM

  Genevieve B. Melton, MD, PhD

  Professor of Surgery
  Univeristy of Minnesota
  Minneapolis, Minnesota, United States

  Disclosure information not submitted.
• 

  Amy J. Thorsen, MD (she/her/hers)

  Associate Professor of Surgery
  University of Minnesota
  Hopkins, Minnesota, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Wolfgang Gaertner, MD, MSc, MBA

  Professor and Chief, Colon & Rectal Surgery
  University of Minnesota
  University of Minnesota
  Minneapolis, MN, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Senior Author(s)

• 

  Paolo Goffredo, MD (he/him/his)

  Assistant Professor
  University of Minnesota
  Minneapolis, MN, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: Length of stay (LOS) is a well-established quality metric following colorectal surgery. Recent evolvements in the field have aimed to reduce LOS, including the growing use of minimally invasive techniques and enhanced recovery after surgery (ERAS) pathways. The aim of the current study was to evaluate the impact of the implementation of a patient education protocol on LOS following colorectal surgery. The secondary outcome was to evaluate its impact on readmission rates within 30 days.

Methods/Interventions: A patient education pathway protocol was developed through a systematic literature review, selection of available components of ERAS protocols, and internal discussion with providers. Adult patients (18-80 years of age) undergoing elective minimally invasive surgery (MIS) or colostomy reversal were included. Open and emergent surgery and abdominoperineal resection cases were excluded. The patient education pathway protocol was reviewed with patients preoperatively at their initial consult and two weeks before the elective operation (Figure 1, Panel A and B). All study patients who received the new education pathway tool were then propensity score matched (2:1), to a historical cohort (2018-2023) to assess its impact on LOS and hospital readmission rates. Age, gender, body mass index (BMI), Charleston Comorbidity Index (CCI), surgical approach, and type of surgery were used as covariates.

Results/Outcomes: A total of 31 participants were enrolled in the study and matched to 62 historical patients. Mean age of the cohort was 57 years (32-77 years), 58% were female, 97% white, and the mean BMI was 27.9 (16-38). The majority had a CCI>2 (52%) and underwent right colectomy (52%) with a robotic approach (74%). Those in the education pathway protocol group had a mean LOS of 2.9 (SD ± 1.1) days compared to the historical cohort of 4.3 days, (SD ± 3.7), while median and interquartile range were 3.1 (2.2-3.3) vs 3.4 (3.0-4.4), respectively. In a linear regression model adjusted for propensity score, a significant reduction in LOS was observed for the experimental arm (p=0.045) with no difference observed in readmission rates (n-4, 13% vs. n=6 10%, p=0.64). In a sensitivity analysis, a Wilcoxon rank sum test also showed a difference in LOS (p=0.005).

Conclusion/Discussion: In this series of patients undergoing MIS or ostomy reversal, the implementation of a preoperative patient education protocol, in the setting of an ERAS pathway, significantly reduced LOS without adversely affecting readmission rates. These findings suggest that detailed perioperative education and patient expectation management enhances preparedness and facilitates earlier discharges.

Figure 1. Panel A. Colon and Rectal Surgery Preoperative Patient Education Pathway
Figure 1. Panel B. Colon and Rectal Surgery Preoperative Patient Education Pathway