RF100 - A propensity-matched prospective pilot study of a Virtual Hospital for same-day discharge after colorectal surgery

Purpose/Background: Virtual Hospital (VH) pathways have been introduced across the National Health Service (NHS) in the United Kingdom to deliver safe, home-based care through remote monitoring. Their application in elective colorectal surgery remains limited by concerns regarding postoperative safety and lack of prospective evidence. This pilot study evaluated the safety, feasibility, and patient experience of a VH pathway following elective colorectal surgery.

Methods/Interventions: Elective colorectal patients were recruited at West Hertfordshire Teaching Hospitals NHS Trust between November 2023 and March 2025. Patients undergoing elective minimally invasive colorectal surgery who were ASA I–II, digitally literate, clinically stable, and able to self-manage were included, while those aged over 75, ASA ≥III, with stoma formation, open surgery, complex social needs, or abnormal postoperative parameters were excluded. Optimal 1:1 propensity score matching was performed for colorectal cancer patients (matched for age, sex, BMI, ASA, and Charlson Comorbidity Index) comparing VH patients with a pre-VH control cohort. Analysis used covariate-adjusted Poisson or binomial regression. VH patients received daily remote monitoring via Masimo SafetyNet™ with consultant oversight. Primary outcomes were inpatient length of stay (IPLOS), VH length of stay (VHLOS), and 30-day readmission. Secondary outcomes included Clavien–Dindo ≥II morbidity, anastomotic leak, unplanned ICU admission, and patient-reported experience.

Results/Outcomes: A total of 367 patients were included. The VH cohort comprised 53 colorectal resections (65%) and 28 stoma reversals (35%), with median [IQR] BMI 27 kg/m² [5] and all ASA I–II. Among resections, 94% were malignant, 6% benign, all achieved R0 resection, and median lymph node yield was 23 [15]. Males represented 51% of resections and 71% of reversals. The overall cohort had a median IPLOS of 4 [4] days and 30-day readmission 14.1%. VH patients had IPLOS 2 [1] days, VHLOS 3 [2] days, and readmission 7.0%. Stoma reversals had IPLOS 1 [0] day and readmission 14.3%, while resections had IPLOS 2 [1] days and readmission 3.3%. Non-VH patients had IPLOS 5 [3] days and readmission 16.1%. In the matched cancer cohort (42 VH vs 42 pre-VH), median IPLOS was significantly reduced (2 vs 5 days, p< 0.001), with no differences in complication, leak, ICU, or readmission rates (all p=ns). Patient survey response was 41%; mean satisfaction 8.5–8.8/10, >90% rated digital monitoring positively, and 95% preferred VH to inpatient recovery.

Conclusion/Discussion: This pilot demonstrates that a technology-enabled postoperative VH pathway is safe, feasible, and highly acceptable to patients after colorectal surgery. VH implementation enabled same-day discharge and halved hospital stay without compromising outcomes, maintaining excellent patient satisfaction. A multicentre randomised trial is now required to validate these findings.