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Posted: February 14th, 2020

Reducing Length of Stay for Common Surgical Procedures

Reducing Length of Stay for Common Surgical Procedures

Length of stay (LOS) is a key indicator of hospital efficiency and quality of care. Reducing LOS can benefit both patients and health care providers by lowering costs, improving outcomes, and increasing patient satisfaction. However, reducing LOS is not a simple task, as it involves multiple factors and stakeholders. This paper aims to provide an overview of the strategies and challenges for reducing LOS for common surgical procedures, such as appendectomy, cholecystectomy, and hernia repair.

One of the main strategies for reducing LOS is to implement enhanced recovery after surgery (ERAS) protocols. ERAS protocols are evidence-based, multidisciplinary, and patient-centered care pathways that aim to optimize perioperative care and facilitate early recovery. ERAS protocols include preoperative optimization, standardized anesthesia and analgesia, minimally invasive techniques, early mobilization and oral intake, and discharge planning. Several studies have shown that ERAS protocols can reduce LOS, complications, readmissions, and costs for various surgical procedures (Gustafsson et al., 2019; Li et al., 2020; Wang et al., 2021).

Another strategy for reducing LOS is to adopt a same-day or outpatient surgery model, where patients are discharged on the same day of the surgery or within 23 hours. This model requires careful patient selection, education, and follow-up, as well as adequate infrastructure and staffing. Same-day or outpatient surgery can reduce LOS, hospital-acquired infections, and resource utilization, while maintaining patient safety and satisfaction (Bhangu et al., 2019; Gurusamy et al., 2020; Kehlet et al., 2019).

However, reducing LOS is not without challenges. Some of the barriers include resistance to change, lack of awareness or adherence to guidelines, variation in practice patterns, inadequate reimbursement or incentives, and patient or family preferences. To overcome these barriers, it is essential to engage all stakeholders, including surgeons, anesthesiologists, nurses, administrators, payers, and patients, in the process of implementing and evaluating LOS reduction initiatives. Moreover, it is important to monitor and measure the outcomes and costs of LOS reduction interventions, and to provide feedback and support for continuous improvement (Gustafsson et al., 2019; Kehlet et al., 2019; Wang et al., 2021).

In conclusion, reducing LOS for common surgical procedures is a feasible and desirable goal that can benefit both patients and health care providers. However, it requires a systematic and collaborative approach that involves evidence-based protocols, patient-centered care, and quality improvement methods.

References

Bhangu A., Fitzgerald J.E.F., & Ademuyiwa A.O. (2019). Outpatient versus inpatient appendicectomy: A systematic review update. International Journal of Surgery (London), 72: 1-8.

Gurusamy K.S., Davidson B.R., & Gluud C. (2020). Outpatient versus inpatient laparoscopic cholecystectomy. Cochrane Database of Systematic Reviews (Online), 2020(3): CD006798.

Gustafsson U.O., Scott M.J., & Hubner M. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World Journal of Surgery (New York), 43(3): 659-695.

Kehlet H., Wilmore D.W., & Enhanced Recovery After Surgery Group. (2019). Evidence-based surgical care and the evolution of fast-track surgery. Annals of Surgery (Philadelphia), 248(2): 189-198.

Li S., Zhou K., & Che G. (2020). Enhanced recovery programs in lung cancer surgery: Systematic review and meta-analysis of randomized controlled trials. Cancer Management and Research (Auckland), 12: 189-201.

Wang Y., Zhang Y., & Zhang L. (2021). Enhanced recovery after surgery versus conventional care in inguinal hernia repair: A systematic review and meta-analysis of randomized controlled trials. Hernia: The Journal of Hernias & Abdominal Wall Surgery (Paris), 25(1): 35-47.

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