Validity and Utility Testing of a Criteria-led Discharge Checklist to Determine Post-operative Recovery after Abdominal
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ORIGINAL SCIENTIFIC REPORT
Validity and Utility Testing of a Criteria-led Discharge Checklist to Determine Post-operative Recovery after Abdominal Surgery: an International Multicentre Prospective Cohort Trial Ianthe Boden1,2 • Calvin Peng3 • Jane Lockstone1,2 • Julie Reeve4,5 • Claire Hackett2,6 • Lesley Anderson5 • Cat Hill7 • Brooke Winzer8 • Nishanthi Gurusinghe3 • Linda Denehy2,9
Accepted: 7 November 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Criteria-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. Methods This 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. Results The 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 \ 0.001) less than actual day of discharge. Conclusion A 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. Trial registration Trials were prospectively registered at the Australian New Zealand Clinical Trials Registry (LIPPSMAckPOP 12613000664741, ICEAGE 12615000318583, PLASTIC 12619001344189, NIPPER PLUS12617000269336).
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05873-9) contains supplementary material, which is available to authorised users. & Ianthe Boden [email protected] 1
Department of Physiotherapy, Launceston General Hospital, Clifford Craig Foundation, TAS, PO BOX 1963, Launceston 7250, Australia
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