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Validity and utility testing of a criteria-led discharge checklist to determine post-operative recovery after abdominal surgery: an international multicentre prospective cohort trial

Boden, I ORCID: 0000-0002-9283-4779, Peng, C, Lockstone, J, Reeve, J, Hackett, C, Anderson, L, Hill, C, Winzer, B, Gurusinghe, N and Denehy, L 2020 , 'Validity and utility testing of a criteria-led discharge checklist to determine post-operative recovery after abdominal surgery: an international multicentre prospective cohort trial' , World Journal of Surgery, vol. 44 , pp. 719-729 , doi: 10.1007/s00268-020-05873-9.

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Abstract

BackgroundCriteria-led discharge (CLD) has promising potential to reduce unnecessary hospital stay after abdominal surgery; however, the validity and utility of CLD is uncertain as studies are limited to small single-centre studies involving predominantly elective colorectal surgery.MethodsThis prospective international multicentre cohort study explored the relationship between a CLD checklist, post-operative recovery, and hospital length of stay using patient-level data from four clinical trials involving 1071 adults undergoing all types of emergency and elective abdominal surgery at five hospitals across Australia and New Zealand. Patients were assessed daily for 21 post-operative days using a standardised CLD checklist. Surgeons and hospital clinicians were masked to findings. Criterion, construct, and content validity of the checklist to accurately reflect discharge decisions by surgical teams, assess physiological recovery, and encompass parameters signalling physiological readiness to discharge were tested. Potential utility of CLD to minimise unnecessary hospital stay was assessed by comparing day of readiness to discharge to actual day of discharge.ResultsThe CLD checklist had concordance with existing discharge planning practices and accurately measured a longer post-operative recovery in more complex clinical situations. The CLD checklist in its current format did not detect all legitimate medical and surgical reasons necessitating a continued stay in hospital. Day of readiness to discharge was 0.8 days (95% CI 0.7 to 0.9, p ConclusionA CLD checklist has excellent criterion and construct validity in measuring physiological recovery following all types of major elective and emergency abdominal surgery. Content validity could be improved. The use of CLD has the potential to reduce unnecessary hospital stay although the safety of discharging patients according to the criteria requires investigation prior to implementation.

Item Type: Article
Authors/Creators:Boden, I and Peng, C and Lockstone, J and Reeve, J and Hackett, C and Anderson, L and Hill, C and Winzer, B and Gurusinghe, N and Denehy, L
Keywords: criteria-led discharge, discharge planning, abdominal surgery, postoperative recovery
Journal or Publication Title: World Journal of Surgery
Publisher: Springer-Verlag
ISSN: 0364-2313
DOI / ID Number: 10.1007/s00268-020-05873-9
Copyright Information:

Copyright 2020 Societe Internationale de Chirurgie

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