IDDF2022-ABS-0189 Surgical high dependency after laparoscopic colectomy: how many actually required intervention?

BackgroundLaparoscopic colectomy is a standard treatment for both benign and malignant conditions. Despite perioperative care advances, a sizable number of post-laparoscopic colectomy patients continue to be warded in Surgical High Dependency (SHD) for observation. Given the high bed occupancy rates, SHD beds, an increasingly scarce resource, should be properly prioritised and allocated to indicated surgical patients. Current literature suggests that a portion of such patients may not require SHD if alternatives (e.g., continuous remote monitoring of vital signs) can be implemented in general wards (GW). This exploratory study aims to retrospectively identify the necessity of SHD stays in a cohort of post-laparoscopic colectomy patients in NUH.MethodsOur cohort consisted of all eligible patients who underwent elective laparoscopic colectomy in NUH in 2021. Deidentified demographic and clinical data, as well as postoperative adverse outcomes for these patients were retrospectively collected.ResultsAmong 149 eligible patients, 28.9% (43/149) were admitted into SHD for postoperative monitoring. The mean length of stay in SHD was 3 days (range 2–10). Among patients admitted to SHD, 65.1% (28/43) required no intervention. However, due to bed transfer logistics, only 34.9% (15/43) of patients were decanted to GW 1–2 days after being deemed medically fit for transfer.ConclusionsMost patients in our cohort initially admitted into SHD did not require postoperative interventions, and/or were admitted for longer than medically required. This translates to an estimated 130 SHD bed-days per annum that could have been freed up for other patients. We postulate that this ‘wastage’ can potentially be avoided with novel models of care, such as continuous remote vital signs monitoring in GW. Assuming interventions by the SHD medical team can also be performed in GW, comparable care quality can be maintained while maximising SHD bed supply for contingencies such as COVID-19.