Why the study?
Hospital capacity within the UK National Health Service is under unprecedented pressure, and reducing admission before the day of elective surgery could reduce bed occupancy and improve patient flow, safety, and experience.
What factors are associated with admission before the day of elective major surgery?
What factors are associated with admission before the day of elective major surgery?
Multiple modifiable patient and system factors, including distance to hospital and preoperative comorbidities, are associated with early admission before elective surgery.
Seventeen percent pre-day admissions signal capacity strain; leaves open targeted interventions to safely defer admission in elective major surgery.
BACKGROUND: Hospital capacity within the UK National Health Service is under unprecedented pressure. Reducing admission before the day of elective surgery might be an opportunity to reduce bed occupancy and improve patient flow, safety, and experience. METHODS: This was a secondary analysis of data from the UK Perioperative Quality Improvement Programme (PQIP), a prospective observational cohort study. Primary outcome was admission to hospital before the day of surgery, and secondary outcome was prolonged postoperative length of stay. We used mixed-effects multivariable regression modelling to evaluate associations with patient, case, and hospital characteristics. RESULTS: We included 54 267 patients undergoing major elective surgery between December 2016 and February 2024, of whom 9124 (17%) were admitted before their surgical date. In adjusted analysis, predictors of early admission included increased straight-line distance from home to hospital (odds ratio 1.93, 95% confidence interval [1.59-2.35] for distance >64 km compared with <6 km), hypoalbuminaemia, anaemia, raised creatinine, poorly controlled diabetes mellitus, use of bowel preparation, failure to complete preassessment, and surgical specialty. Likelihood of early admission was clustered by hospital (intraclass correlation coefficient=0.527). Postoperative length of stay was associated with identifiable case-level factors that explained most of the observed variation (intraclass correlation coefficient=0.063). CONCLUSIONS: Multiple risk factors for admission before day of surgery could be addressed through policy or local quality improvement. Unexplained variation at the hospital level might reflect local culture and process, which should be explored in future research. We recommend exploring hotel-type accommodation as a potentially cost-effective alternative to preoperative inpatient admission for suitable patients.
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Hou et al. (2025) studied this question.
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