The postoperative period significantly influences the overall success of a medical procedure, regardless of its magnitude. Efficient and timely discharge is crucial for a patient’s recovery, reducing the risk of complications and optimizing healthcare resource utilization. This article delves into the intricacies of establishing discharge criteria after surgery, emphasizing the importance of standardized guidelines to determine if a patient is ready to leave the hospital. The type of surgery, patient status and risk factors, and how the surgery proceeded are all important to consider. As a result, research must examine specific situations, and clinicians must evaluate patients individually.

Studies on colorectal surgery affirm the safety of early discharge, even as early as the day of the surgery (Tavernier et al., 2022). However, the determination of discharge readiness after surgery should rely on well-defined criteria. The primary influencers of these criteria are the patient’s physiological stability. Monitoring vital signs, such as heart rate, blood pressure, respiratory rate, and temperature, is essential for assessing the body’s response to surgical intervention. Stable vital signs indicate successful navigation through the immediate postoperative period, reducing the likelihood of complications upon discharge (Chung, 1995).

Effective pain management is also integral to a patient’s postoperative recovery, impacting both comfort and functional independence. Managing pain in the ambulatory surgical setting presents challenges, as certain medications such as opiates may increase the likelihood of postoperative nausea and vomiting (Marshall & Chung, 1999). A multimodal approach is crucial to prevent inadequate pain treatment (Marshall & Chung, 1999). A patient must be discharged with an appropriate pain control plan.

Nutritional status is also important to a patient’s recovery following surgery, influencing wound healing and immune system function. Whether through oral, enteral, or parenteral nutrition, the care team must ensure the patient maintains adequate nutrition. While a patient who is actively vomiting should never be discharged, it is not always necessary to ensure patients must demonstrate they can tolerate oral fluids prior to discharge. For example, in an ambulatory surgery setting, tolerance of oral fluids prior to discharge may not necessarily be part of discharge criteria (Marshall & Chung, 1999). However, for example in the setting of colorectal surgery, out of 156 studies, 80% described hospital discharge which required tolerance of oral intake (Fiore et al., 2012). Various factors that should be considered when determining if a patient must tolerate oral fluids prior to discharge include age, medical comorbidities, distance from home, availability of a caretaker, and hydration status (Chung, 1995).

A patient’s psychosocial status must also be considered prior to discharge. The care team must consider a patient’s mental, emotional, and social status to ensure they have a safe discharge (Chung, 1995).  Any post-surgery discharge criteria should encompass plans for appropriate and timely follow-up care, including postoperative appointments, prescription accessibility, and comprehension of at-home care instructions. Patients must also be educated on when to contact the healthcare team or seek emergency care.

In conclusion, discharge criteria after surgery must include a comprehensive, multifaceted assessment of many factors not limited to but including a patient’s physiological state, pain management, nutritional status, psychosocial well-being, and follow-up plans. Validated assessment tools and evidence-based practices are essential for ensuring successful patient outcomes, with criteria varying based on the specific surgery and setting (Fiore et al., 2012). Healthcare staff can then systematically assess patient status and communicate the postoperative course and plans.

References

Chung, F. “Discharge criteria–a new trend.” Canadian journal of anaesthesia = Journal canadien d’anesthesie vol. 42,11 (1995): 1056-8. doi:10.1007/BF03011083

Fiore, J F Jr et al. “Hospital discharge criteria following colorectal surgery: a systematic review.” Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland vol. 14,3 (2012): 270-81. doi:10.1111/j.1463-1318.2010.02477.x

Marshall, S I, and F Chung. “Discharge criteria and complications after ambulatory surgery.” Anesthesia and analgesia vol. 88,3 (1999): 508-17. doi:10.1097/00000539-199903000-00008

Tavernier, Clement et al. “Assessing Criteria for a Safe Early Discharge After Laparoscopic Colorectal Surgery.” JAMA surgery vol. 157,1 (2022): 52-58. doi:10.1001/jamasurg.2021.5551