Evaluation System Reduces Ineffective Hospital Days in Colorectal Cancer Care

A new evaluation index system, developed using the Appropriateness Evaluation Protocol (AEP) framework within the Enhanced Recovery After Surgery (ERAS) model, provides targeted guidelines for early and safe discharge, cutting hospitalization costs while improving recovery efficiency for patients with colorectal cancer (CRC).1

This analysis is published in BMC Nursing.

Researchers have developed an evaluation protocol index to optimize postoperative recovery. | Image credit: mi_viri - stock.adobe.com

“Through ongoing feedback from practice and optimization adjustments, we aim to enhance the global applicability of this evaluation indicator system, thereby providing more scientifically grounded and reasonable guidance for the postoperative recovery of colorectal cancer patients worldwide,” wrote the researchers of the study. “Additionally, we encourage experts and scholars from various regions to further validate and optimize this indicator system based on local conditions, ensuring its better adaptation to the local medical environment and patient needs.”

ERAS is a multimodal approach to surgical care designed to enhance recovery, particularly for patients undergoing colorectal bowel resections.2 By implementing evidence-based protocols, ERAS can help reduce pain, accelerate recovery, and shorten hospital stays, leading to improved patient outcomes.

In the analysis, the researchers aimed to standardize discharge criteria and reduce ineffective hospital days (IHD) for patients with CRC.1

The initial framework was informed by an extensive literature review and in-depth discussions among the research team, including 17 consulting experts from 11 tertiary hospitals in China. To refine the system, experts participated in 2 rounds of Delphi consultations, providing insights and consensus-based recommendations. Following a thorough analysis of expert feedback, the final index system was established, with weight calculations assigned to each indicator to ensure a structured and evidence-based approach to evaluating postoperative hospital days.

The study achieved a 100% response rate across the 2 rounds of expert consultations, demonstrating strong engagement and consensus among participants. The expert authority coefficients were 0.903 and 0.918, indicating a high level of reliability in expert evaluations. Variation coefficients ranged from 0.070 to 0.225 in the first round and 0 to 0.135 in the second, reflecting a progressive refinement of the index system.

Additionally, Kendall’s harmony coefficients of 0.397 and 0.291 further confirmed agreement among experts. The finalized evaluation index system for postoperative IHD in patients with CRC within the ERAS framework comprised 4 indicators related to medical services, 4 for nursing and life support services, and 7 for patient condition factors, providing a structured and comprehensive tool for optimizing discharge criteria and recovery outcomes.

However, the researchers acknowledged some limitations to the analysis. First, while the Delphi method effectively gathered expert opinions and consensus through iterative anonymous feedback, it inherently relied on subjective judgment and experience. Second, the Kendall coefficients for the 2 rounds of consultations were relatively low, with a decline in the second round, potentially indicating increased subjectivity in expert scoring over time.

Finally, the developed evaluation index system assumes effective ERAS implementation, making it more applicable to well-equipped institutions with advanced technical resources. For health care facilities with limited ERAS adoption or resource constraints, modifications and adaptations may be necessary to ensure the system’s practicality and effectiveness in diverse clinical settings.

Despite these limitations, the researchers believe that by addressing inconsistencies in post-surgical discharge practices, this framework promotes optimal use of medical resources and enhances treatment outcomes for patients with CRC worldwide.

“This index system is anticipated to have a direct positive impact on patient outcomes by optimizing hospital stay, improving resource utilization, and enhancing postoperative recovery,” wrote the researchers. “Future research should focus on further empirical studies of the index system, modifying and refining it to provide a reference for the accurate and efficient assessment of ineffective hospital days following colorectal cancer surgery, thereby achieving standardization of discharge criteria.”

References

1. Sun J, Zhang Q, Ma J, et al. Development of an evaluation index system for inappropriate hospital admissions after colorectal cancer surgery in the context of enhanced recovery after surgery. BMC Nurs. 2025;24(1):154. doi:10.1186/s12912-025-02777-8

2. Enhanced recovery after surgery. American Society of Colon & Rectal Surgeons. Accessed February 12, 2025. https://fascrs.org/patients/diseases-and-conditions/a-z/enhanced-recovery-after-surgery#:~:text=Enhanced%20recovery%20after%20surgery%2C%20known,shorter%20hospital%20stay%20with%20ERAS