Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

Delayed discharge for non-clinical reasons among stroke patients in a high-complexity hospital: A cross-sectional study

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007-2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The mean age was 80.22 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost

Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007–2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups’ weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.

Delayed Discharge after Thoracic Surgery under the Guidance of ERAS Protocols

Background Enhanced recovery after surgery (ERAS) protocols have been applied in thoracic surgery and are beneficial to patients. However, some issues about ERAS are still pending. Methods A total of 1,654 patients who underwent thoracic surgery under the guidance of ERAS protocols were enrolled in this study. We set the length of postoperative stay (LOPS) as our key research indicator. Patients were divided into routine discharge group and delayed discharge group based on LOPS. Causes of delayed discharge were analyzed to improve management of postoperative recovery. Results Male, old age, underlying disease (coronary artery disease, chronic kidney disease, old cerebral infarction, chronic obstructive pulmonary disease, and arrhythmia), intensive care unit (ICU) stay, type of insurance, and lower forced expiratory volume in one second (FEV1) are the independent impact factors causing delayed discharge. Increased nonchylous drainage (INCD) and prolonged air leakage were the two leading causes for delayed discharge. Conclusion Patients should have personalized recovery goal under the same ERAS protocols. We should accept that patients in poor general condition have a prolonged LOPS. More stringent ICU stay indications should be developed to increase postoperative patients' ERAS protocols compliance. Further research on chest tube management will make a contribution to ERAS protocols.

Impact of Urinary Catheterization on Postoperative Outcomes After Roux-En-Y Gastric Bypass Surgery in Propensity-Matched Cohorts

Background The impact of urinary catheter avoidance in bariatric enhanced recovery after surgery (ERAS) protocols is yet to be established. The purpose of the current study is to determine whether urinary catheter use in patients undergoing Roux-en-Y gastric bypass (RYGB) procedures has an effect on postoperative outcomes. Methods An institutional database was utilized to identify adult patients undergoing primary minimally invasive RYGB surgery. Outcomes included incidence of urinary tract infection (UTI) within 30 days postoperatively, 30-day readmission rates, proportion of patients discharged after postoperative day 1 (delayed discharge), length of stay (LOS), and operating room time. These were compared between propensity-matched groups with and without urinary catheter placement. Results There were no significant differences in postoperative UTI’s (2.2% for both cohorts, P = .593) or 30-day readmission rates for patients with and without urinary catheters (6.6% and 4.4%, respectively, P = .260). Mean LOS (1.7 vs. 1.5 days, P = .001) and the proportion of patients having a delayed discharge (47.3% vs. 33.7%, P = .001) was greater in patients with a catheter. Operating room time was longer in the urinary catheter group (221.8 vs. 207.9 minutes, P = .002). Discussion Avoidance of indwelling urinary catheters in RYGB surgical patients decreased delayed discharges and LOS without affecting readmission or reoperation rates. Therefore, we recommend that avoidance of urinary catheters in routine RYGB surgery be considered for inclusion into standardized ERAS protocols. Urinary catheters should continue to be utilized in select cases, however, as these were not shown to affect rate of UTIs.

467 Impact of the Coronavirus Pandemic on Acute Surgical Patients’ Discharge Summaries

Background The emergence of the Coronavirus pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single centre has possibly negatively impacted on the effective discharge notification of acute surgical patients. Methods: Discharge summaries of all patients discharged from a Surgical Assessment Unit were collected and analysed, to identify the date of completion and grade of responsible clinician. Data collection was carried out over three weeks before the initiation of lockdown measures and continued for a further three weeks during the peak of the Coronavirus pandemic with a three-week interventional period in between. Results In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, with an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for this was due to time constraints. Conclusions The reallocation of surgical staff has affected communication between primary and secondary care. Given the potential repercussions of these delays, healthcare systems should be made aware of this consequence, especially in preparation for any future resurgences.