Drinking, eating, and mobilising (DrEaMing) as a postoperative outcome measure in patients following major elective colorectal cancer surgery: a prospective cohort study

Abstract

Purpose: Evaluating functional recovery after surgery is an important patient-centred outcome. In the UK, recovery is commonly measured by patients' drinking, eating, and mobilising (DrEaMing) in the first 24 h after surgery, although the validity and the best measurement timing are unknown.

Method: This study aimed to review the DrEaMing patterns in a cohort of 360 colorectal patients during the first three days after oncological surgery, study the associations of DrEaMing with prolonged length of hospital stay (LOS > median) and significant morbidity (Clavien-Dindo ≥ II), and whether pre- and intraoperative variables could predict DrEaMing.

Results: After achieving DrEaMing, 63.3 % continued to DrEaM on subsequent postoperative day(s). Although DrEaMing on each day was significantly associated with morbidity and LOS, not DrEaMing on postoperative day (POD) 3 was best associated with a LOS >6 days (pseudo R² = 0.173, p < 0.001), and significant morbidity (pseudo R² 0.028, p = 0.008) and was predicted by duration of surgery and surgical approach (R² = 0.365, p < 0.001). Furthermore, median LOS (IQR) and morbidity (%) differed significantly between patients who, during POD 1-3, continued DrEaMing (5(4-8); 21.9 %), stopped DrEaMing (regression) (9(5-15); 26.1 %), and those who did not DrEaM at all (8(6-15); 36.7 %).

Conclusions: DrEaMing is a valid patient-centred outcome measure in elective colorectal surgery and a marker of surgical recovery. Failure to DrEaM on POD 3 and DrEaMing regression are associated with postoperative morbidity and prolonged LOS. DrEaMing could therefore be further implemented as an easy patient-centred outcome, adding to a better overview of a patient's recovery besides the measurement of traditional outcomes.