Outcome measures
The primary outcome was
postoperative LOS defined as whole days from the day of surgery until
discharge. According to China’s medical insurance policy, reimbursement
can only be made if the LOS is more than one day, therefore, same day
discharge has not yet become routine practice in our hospital. To adjust
for the potential impact of the insurance policy and other nonmedical
variables (i.e. social problem, patients’ concern, etc.) on LOS, a
theoretical LOS was introduced, using the theoretical day of discharge,
defined as the postoperative day when patients met the following
predefined criteria: adequate pain control with oral analgesics, absence
of vomiting or severe nausea, absence of body temperature ≥ 37.5°C,
tolerance of solid food, and ambulation as preoperative.
Secondary outcomes included a numerical rating scale (NRS) score for
postoperative pain, time to first flatus, simplified PONV impact scale
score as previously described,13 postoperative 30-day
complication (defined as any postoperative 30-day or in-hospital
complication, according to the Clavien-Dindo classification)14, quality of life, readmission rate, and in-hospital
cost. Quality of life was assessed on POD 3 with a Chinese-validated
version of the Quality of Life-15 (QoR-15)
questionnaire.15
We collected data via a secure dedicated website, and during
hospitalization medical and nursing staff reported daily on patient
status. The predefined discharge criteria were scored daily by an
independent doctor blinded to group. Patients were systematically
followed at an outpatient clinic and were evaluated for any
complications or readmission occurring after discharge within 30 days of
the operation.