Rectal Cancer Infections, Length of Stay and Discharge-to-Home Rate Gains Achieved at Hackensack University Medical Center
Real-time, multidisciplinary care planning and outcomes assessment underpin continual improvements in rectal cancer outcomes
The colorectal surgery team at Hackensack University Medical Center sees patients experience faster recovery and fewer complications from rectal cancer surgery when discharged home, versus a rehabilitation facility, as soon as feasible.
Accordingly, Steven Lee-Kong, M.D., division chief of Colorectal Surgery at Hackensack University Medical Center, set forth the goal of continual protocol enhancements, and frequent multidisciplinary discussions to support speedy recoveries after rectal cancer surgery. As a result the center exceeded its SIR target with a 1.26 rate. And, discharge-to-home rates are currently 91.5%. Of 50 rectal cancer surgery cases in 2023, average length of stay was 5.9 days (0.89 length-of-stay index), with just 4% readmitted within 30 days and 0% mortality.
“We’ve implemented an enhanced recovery pathway that includes infection reduction efforts and mechanically pushed and oral antibiotics,” Dr. Lee-Kong said. The team has found value in initiating IV antibiotics before transition to the OR. For patients with diabetes, the surgical care team closely monitors glucose levels, as spikes can lead to surgical site infections.
During rectal cancer procedures, surgeons use colonoscopes to ensure no anastomosis, or if found, to address it before the patient leaves the OR. Fluorescent imaging helps surgeons ensure perfusion of the intestines to further reduce post-op complications.
Longer length of stay increases risk of post-operative complications such as surgical site infections, so the team does everything possible to shorten patient stays. This includes refining medical protocols, such as removing urinary catheters sooner to avoid UTIs and immediately starting solid foods rather than a liquid diet. Opioid-sparing, multimodal pain control helps ensure better intestinal function than narcotic options.
Many patients will require a stoma or ileostomy after surgery, so patients meet with an enterostomal therapist in the office prior to the procedure, which can ease patient anxiety and smooth the recovery process. Elderly or frail patients are prescribed prehabilitation to improve functionality and recovery.
Refinements also include administrative efficiencies, such as initiating social work referrals upon admission to begin planning PT, OT and home nurse visits.
These data-driven best practices derive from and are continually refined in monthly colorectal surgery team conferences assessing actual patient case outcomes. Additionally, monthly multidisciplinary patient reviews with colorectal surgery, medical oncology, radiation oncology, radiology, pathology and gastroenterology ensure multifaceted treatment recommendations and mid-treatment reviews for every rectal cancer patient. The system-wide shared EHR streamlines the multidisciplinary care approach as well.
Learn more about innovations in gastroenterology at Hackensack University Medical Center.
