The primary months of the COVID pandemic had a profound impact on hospital discharge practices and use patterns for sufferers with colorectal illness, in keeping with findings introduced on the Scientific Discussion board of the American School of Surgeons (ACS) Scientific Congress 2022. A examine of greater than 100,000 surgical sufferers who underwent procedures for colorectal most cancers discovered that that they had 40% decrease odds of being discharged to post-hospital rehabilitation throughout the pandemic than earlier than.
Regardless of this considerably decrease charge, the hospital readmission charge didn’t change from pre-pandemic ranges, stated Marc Mankarious, MD, a surgical resident at Penn State Hershey Medical Heart, Hershey, Pennsylvania.
We discovered that discharge to a rehabilitation facility pre-pandemic was 10%, which agreed with earlier literature, however as soon as the pandemic hit, the discharge-to-rehabilitation charge dropped to about 7%. We noticed a drop of three proportion factors, regardless that we had been doing extra emergent operations and extra open operations, that are typical threat components for requiring rehabilitation after surgical procedure.”
Dr. Marc Mankarious, MD, Surgical Resident, Penn State Hershey Medical Heart, Hershey, Pennsylvania
The authors hypothesized that anecdotally, concern of going into confined areas, workers and provide shortages, and illness outbreaks contributed to modifications in discharge practices.
Concerning the examine
The retrospective cohort examine used two databases from the American School of Surgeons Nationwide Surgical High quality Enchancment Program (ACS NSQIP®): the Participant Use File and Goal Colectomy databases. Researchers analyzed knowledge on 116,677 sufferers: 90,250 from 2017 by means of 2019, and 26,427 from 2020. For comparability, the primary quarter was excluded from all years as a result of the primary COVID restrictions didn’t go into impact till March 2020. ACS NSQIP is the main nationally validated, risk-adjusted, outcomes-based program to measure and enhance the standard of surgical care in hospitals. It was created by surgeons to assist hospitals gauge the standard of their surgical applications and enhance surgical outcomes by gathering sturdy, correct, and exact medical affected person info.
Key findings
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In evaluating the pre- and post-COVID-19 intervals, the proportion of emergent instances and open operations-;versus minimally invasive procedures-;elevated in 2020, from 13 to fifteen% (p<0.001) and 31 to 32% (p<0.001), respectively.
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A multivariable evaluation discovered that sufferers in 2020 had 40% decrease odds of going to a post-discharge facility (odds ratio 0.62, p<0.001), even after the evaluation adjusted for causes for having the operations and different medical situations the sufferers had.
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The charges of sufferers going again to the hospital inside 30 days of discharge was 10% in each intervals (p=0.4).
Surgeons’ observations
The soundness in hospital readmission charges was telling as a result of which may be “one of many components that goes into deciding whether or not to supply a rehabilitation keep to a affected person,” Dr. Mankarious stated.
The examine knowledge didn’t embrace explanation why sufferers did or didn’t select to go to post-discharge rehabilitation to get well; the authors hypothesized that components included restricted availability of beds and affected person considerations about customer restrictions and contracting COVID-19 Dr. Mankarious stated. However the pandemic noticed a 63-fold enhance in telehealth use in 2020 over 2019. “This example could have made sufferers and physicians extra snug with the affected person going house and following up with one another electronically,” he stated.
The info included some info on medical causes for going to rehabilitation. “We did discover that sufferers that went to rehabilitation in 2020 had been extra functionally dependent or functionally impaired than sufferers that went to rehabilitation in earlier years, so these components may additionally play a component in it.” Dr. Mankarious stated.
The examine grew out of what surgeons at Penn State Hershey had been observing within the early days of the pandemic, stated senior creator Audrey Kulayat, MD, assistant professor of colorectal surgical procedure. “We questioned if these observations had an impression on an even bigger scale different than simply at our establishment,” she stated. “However then we needed to know, what is the draw back? Was there a draw back? Are sufferers getting readmitted extra often on account of going again to their house or no matter establishment versus going to a spot with a better stage of nursing care? We did not discover that they had been readmitted extra typically.”
Potential change in discharge apply
The examine findings elevate questions in regards to the potential overuse of posthospital rehabilitation for colorectal sufferers, Dr. Mankarious stated. “Medicare spends about $60 billion per 12 months on sufferers going to post-acute care amenities or rehab usually and any small reductions, even our 3% discount, which was important, might lead to appreciable value financial savings for the healthcare system.
“And it actually helps us rethink who ought to go to post-surgery rehab, perhaps elevate our thresholds as we grow to be extra snug sending sufferers house and have higher utilization of the brand new obtainable modalities to assist us observe up with them with out having to ship them to rehab,” Dr. Mankarious added.
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