Introduction The implementation and evaluation of Enhanced Recovery after Surgery programmes over the past 15 years has ensured the accurate reporting of inpatient morbidity post colorectal resection. However, there is a paucity of audit or research examining post-operative morbidity in the early discharge period.
Method 142 consecutive patients undergoing elective (n = 98) or emergency (n = 44) colorectal resection over a three-month period were invited to attend a nurse-led outpatient clinic at 30 days post-discharge. Audit data were collected at two time-points, discharge from hospital and at clinic. Audit templates were developed using the Postoperative Morbidity Survey,1Clavien-Dindo classification criteria2and modified to include additional colorectal surgery-specific outcomes. Results were recorded and analysed using SPSS.
Results Unanticipated findings relating to post-discharge morbidity identified through the audit included: 35% (n = 32) of infection-free inpatients developed surgical site infections following discharge. 34% (n = 47) of all patients had significant urinary symptoms when seen in clinic. Dietary implications at 30 days post-discharge included an appetite of half or less than usual intake in 27% of patients (n = 37) and moderate to major changes in dietary intake compared to their pre-operative diet in 30% (n = 42). 27% (n = 38) of patients had an ileostomy; of those without an ileostomy, 20% (n = 21) had four or more daily bowel movements, with 22% (n = 23) describing their stool consistency as watery, loose or unsettled. 45% (n = 46) of those without an ileostomy reported one or more problematic bowel symptom related to their surgical experience at 30 days post-discharge.
Conclusion These audit findings suggest that individuals undergoing colorectal resection experience significant levels of post-discharge morbidity, extending the burden on them and the services required to support them for longer than may have been previously anticipated. Nurse-led follow-up using auditable documentation templates facilitates the recognition and reporting of complications following discharge and provides valuable support for patients.
Disclosure of interest None Declared.
Grocott MPW, et al. The Postoperative Morbidity Survey was validated and used to describe morbidity after pelvic surgery. J Clin Epidemiol 2007;60:919–928
Dindo D, et al. Classification of Surgical Complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213
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