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. 2024 May 1;279(5):727-733.
doi: 10.1097/SLA.0000000000006180. Epub 2023 Dec 20.

Effectiveness and Safety of Postoperative Hospital at Home for Surgical Patients: A Cohort Study

Ainoa Ugarte  1   2   3 , Irene Bachero  4 , David Cucchiari  5 , Marta Sala  1 , Irene Pereta  1 , Eva Castells  1 , Nuria Subirana  1 , Andrea Loscos  1 , Laura García  1 , Celia Cardozo  1   3   6 , Verónica Rico  1   3   6 , Nicol García-Poutón  1   3   6 , Manuel Torres  1   2 , Carlos Lopera  1   3   6 , Anna Aldea  1   2 , Adolfo Suárez  1 , Emmanuel Coloma  1   2   3 , Nuria Seijas  1 , Jordi Altés  1 , David Nicolás  1   2   3
Affiliations

Effectiveness and Safety of Postoperative Hospital at Home for Surgical Patients: A Cohort Study

Ainoa Ugarte et al. Ann Surg. .

Abstract

Objective: To determine the feasibility and effectiveness of a Hospital at Home (HaH) enabled early transfer pathways for surgical patients.

Background: HaH serves as a safe alternative to traditional hospitalization by providing acute care to patients in their homes through a comprehensive range of hospital-level interventions. To our knowledge, no studies have been published to date reporting a large cohort of early home-transferred patients after surgery through a HaH unit.

Methods: Cohort study enrolling every patient admitted to the HaH unit of a tertiary hospital who underwent any of 6 surgeries with a predefined early transfer pathway and fitting both general and surgery inclusion criteria (clinical and hemodynamic stability, uncomplicated surgery, presence of a caregiver, among others) from November 2021 to May 2023. Protocols were developed for each pathway between surgical services and HaH to deliver the usual postoperative care in the home setting. Discharge was decided according to protocol. An urgent escalation pathway was also established.

Results: During the study period, 325 patients were included: 141 were bariatric surgeries, 85 kidney transplants, 45 thoracic surgeries, 37 cystectomies, 10 appendicectomies, and 7 ventral hernia repairs. The overall escalation of care during HaH occurred in 7.3% of patients and 30-day readmissions in 7%. Most adverse events were managed at home and the overall mortality was zero. The total mean length of stay was 8 days (interquartile range 2-14), and patients with HaH were transferred home 3 days (interquartile range 1-6) earlier than the usual pathway; a total of 1551 bed-days were saved.

Conclusions: The implementation of early home transfer pathways for surgical patients through HaH is feasible and effective, with favorable safety outcomes.

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Conflict of interest statement

The authors report no conflicts of interest.

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