Decreasing Post-Operative Complications with Presurgical Education Programs: Reducing Lengths of Stay and Readmissions

The purpose of this project was to examine the impact of preoperative patient education on length of stay and readmission rates. Rates of readmission after colorectal surgery exceed hospital readmission rates for any other surgical procedure with total cost of patient care exceeding $37,000 per colorectal patient and is significantly higher when complications occur. Colorectal surgery complications have been found to increase healthcare costs upwards of 196%.

The American Society of Colon and Rectal Surgeons (ASCRS) Clinical Practice Guidelines Committee determined standard length of stay after colorectal surgery to be 5-8 days and readmission rates to be as high as 35.4%. Almost 8% of 12,732 patients were readmitted and being able to favorably change the rate of readmissions could potentially save $3.6 million for every 1000 colorectal readmissions.

A literature review was performed using keywords (colorectal surgery, readmissions, colorectal complications, colorectal surgery education, preoperative education). A setting was selected for implementation and written approval from required bodies for use of these was obtained. Approval from the university IRB was obtained, and participants were selected from a large colorectal clinic. Informed consent was obtained from the participants, the project was implemented. Collected data was statistically analyzed and reported via a written platform.

A pre-operative teaching session, 1-3 hours in duration, was conducted within 30 days of the operation. It was provided live for available participants and virtually for those unable to attend. The education was provided by the principal investigator who has more than seven years’ experience in providing care to colorectal patients. Education was administered verbally using PowerPoint presentation. Participants were provided a hard copy of the presentation before the program to promote note taking. For those unable to attend, the hard copy was sent via mail with delivery confirmation and/or email.

Of the 55 participants, 34 were control participants and 21 were experimental. There was a statistically and clinically significant decrease in readmission rates. Of the 21 experimental participants, zero were readmitted after discharge, and 9 of the 34 control participants were readmitted. There was a decrease in the overall total length of stay from 3.76 to 3.43 days.

Evidence-based project findings from research support an individualized approach to patient care in helping to reducing healthcare costs. Narrowed focus on patient education assists patients to better care for themselves, in turn, also decreasing morbidity and mortality. Consumers and providers would benefit from the decrease in costs, morbidity, and mortality. The financial benefit from cost savings would allow healthcare systems to approach their nursing workforce and face those fighting for fair workloads from a positive business advantage.