Postoperative Day 0 Restraint and Prolonged Use in Older Colectomy Patients Receiving Dementia Care

Objectives In Japan, physical restraints are commonly used in surgical care, despite growing concerns regarding their adverse effects. We aimed to examine the association between physical restraint on the day of surgery and subsequent restraint use, as well as length of stay among older adults undergoing colectomy for colon cancer who were eligible for dementia care. Design A retrospective cohort study. Setting and Participants Patients aged ≥65 years who had undergone colectomy for colon cancer and were eligible for dementia care in Japan were included in the study. Methods Data collected in the Japanese Diagnosis Procedure Combination database between April 2020 and March 2021 were retrospectively reviewed. The associations between physical restraint on the day of surgery (postoperative day 0 [POD 0]) and restraint use on POD 7 and postoperative length of stay were examined using multivariable regression analyses. For the analysis of postoperative length of stay, a modified study population was used in which complete restraint data through POD 7 were not required, provided that restraint status on POD 0 was ascertainable. Results Among the 760 patients included in the primary analysis, 28.3% were physically restrained on POD 0. Restraint on POD 0 was associated with higher odds of restraint on POD 7 (odds ratio, 7.27; 95% CI, 4.56-11.60). In the secondary analysis (n = 962), restraint on POD 0 was not associated with postoperative length of stay (adjusted coefficient, 0.05 days; 95% CI, −1.32 to 1.42). Conclusions and Implications Physical restraint on the day of surgery was associated with restraint use on POD 7, suggesting the need for careful evaluation at the time of initiation. Patients restrained early after surgery may warrant careful reassessment of the continued need for restraint during the postoperative period.