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Optimization of Peri-Operative Hdu Care for Elective Colorectal Patients

Siddique K, Cheema MR, Bapat P and Titu L

Background: Despite recent advances,high-risk patients undergoing elective colorectal surgery still have significant morbidity and mortality. For patients electively admitted to level II care, premature discharge can contribute to poor outcomes.

Objectives: The main objectives were to review the level II care provided to high-risk elective colorectal patients with regards to their timing of discharge from the HDU and rate of post-operative complications, re-admissions, total length of stay (LOS) and mortality.

Methods: All elective colorectal patients admitted to HDU during 2010 were included. Patients were divided into two groups with regards to their stay on HDU: Group1 ≤ 48 hrs and Group2 >48 hrs. Data regarding demographics, post-operative complications, LOS, re-admission to HDU and mortality were collected and analysed using SPSS version 14.

Results: Out of the total of 40 patients, 24 (60%) were females; the median age was 74 (IQR 45-92) years. Laparoscopic procedures were performed in 31 (77.5%) patients. There were 26 patients in Group 1 and 14 in Group 2. Post-operative complications were higher (72.2% Vs 27.8%, p-value=0.04), and the LOS was significantly longer amongst Group 1 patients [8 (IQR 4-41) Vs 6.5(IQR4-12) days, p-value 0.03). Four patients in Group 1 were readmitted to HDU compared to none in Group 2. No mortality was observed. 

Conclusion: Early discharge from the HDU is associated with significant risk of complications, HDU re-admission (10%) and prolonged LOS. Ensuring a minimum HDU stay of 48 hrs could reduce post-operative morbidity, thus optimizing HDU patient care.