Gastroenterological surgery

Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England (2025)

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Type of publication:

Journal article

Author(s):

Dawes, Mindy; Packman, Zoe; McDonald, Ruth A; *Cheetham, Mark J; Gallagher-Ball, Nannette M T; Warwick, Eleanor; Oyston, Maria; McCone, Emma; Snowden, Chris; Swart, Michael; Briggs, Tim W R; Gray, William K.

Citation:

British Journal of Anaesthesia. 2025 Apr 22.

Abstract:

BACKGROUND: Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

METHODS: This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >=17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

RESULTS: Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.

CONCLUSIONS: We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England (2025)

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Type of publication:
Journal article

Author(s):
Ayyaz, F M; Joyner, J; *Cheetham, M; Briggs, Twr; Gray, W K.

Citation:
Annals of the Royal College of Surgeons of England. 107(1):54-60, 2025

Abstract:
INTRODUCTION: The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS: This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic
cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS: Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December
2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of
prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS: Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

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Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). (2014)

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Type of publication:
Journal article

Author(s):
*Chandra A, *Clarke R, *Shawkat H

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202864.abstract