Improving patient activation may be an effective way to reduce healthcare costs and improve patient outcomes after surgery. To determine whether preoperative patient activation is associated with delayed discharge (i.e., length of stay >24 h) after elective laparoscopic cholecystectomy. Postoperative symptoms, unscheduled access to healthcare facilities within seven days of surgery, unplanned hospital readmissions, and postoperative complications were analyzed as secondary outcomes. This cohort study was a secondary analysis of the DeDiLaCo study (Delayed Discharge after day-surgery Laparoscopic Cholecystectomy) collecting data of patients undergoing elective laparoscopic cholecystectomy during 2021 in Italy. Data was analyzed from June 2022 to April 2023. 90 Italian surgical centers participating in the study. 4708 adult patients with an instrumental diagnosis of gallbladder disease and undergoing laparoscopic cholecystectomy. Patient activation was assessed using the Italian translation of Patient Activation Measure in the preoperative setting. Of 4532 cases analyzed the median (IQR) Patient Activation Measure score was 80.3 (71.2–92.3). Participants were on average 55.5 years of age and 58.1 % were female. Two groups based on the activation level were created: 270 (6 %) had low activation, and 4262 had high activation. The low activation level was associated with the likelihood of delayed discharge (odds ratio [OR] 1.47, 95 % CI, 1.11–1.95; P = .008), higher symptom burden (OR 1.99, 95 % CI 1.49–2.66, P < .0001), and unplanned healthcare utilization within seven days after hospital discharge (OR 1.85, 95 % CI, 1.29–2.63; P = .001). There was no difference between the high and low activation groups in the incidence of postoperative complications (OR 1.28, 95 % CI, 0.95–1.73; P = .10) and hospital readmission after discharge (OR 0.95, 95 % CI, 0.30–3.05; P = .93). Our results suggest that patients with low activation have 1.47 times the risk of delayed discharge compared with patients with higher activation, almost twice the risk of the onset of postoperative symptoms, and 1.85 times the risk of unscheduled use of hospital services. Screening for patient activation in the preoperative setting could not only identify patients not suitable for early discharge, but more importantly, help physicians and nurses develop tailored interventions.

中文翻译：

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择期腹腔镜胆囊切除术中患者激活与延迟出院之间的关联：前瞻性队列分析


提高患者的积极性可能是降低医疗成本和改善术后患者预后的有效方法。确定术前患者激活是否与择期腹腔镜胆囊切除术后延迟出院（即住院时间 >24 小时）相关。术后症状、手术后 7 天内非计划前往医疗机构、计划外再入院和术后并发症作为次要结果进行分析。该队列研究是 DeDiLaCo 研究（日间手术腹腔镜胆囊切除术后延迟出院）的二次分析，该研究收集了 2021 年在意大利接受择期腹腔镜胆囊切除术的患者数据。数据分析时间为 2022 年 6 月至 2023 年 4 月。90 个意大利外科中心参与了这项研究。 4708 名经仪器诊断为胆囊疾病并接受腹腔镜胆囊切除术的成年患者。在术前环境中使用意大利语翻译的患者激活测量来评估患者激活。在分析的 4532 例病例中，患者激活测量得分中位数 (IQR) 为 80.3 (71.2–92.3)。参与者平均年龄 55.5 岁，其中 58.1% 为女性。根据激活水平创建了两组：270 人（6%）具有低激活性，4262 人具有高激活性。低激活水平与延迟出院的可能性（比值比 [OR] 1.47，95% CI，1.11–1.95；P=.008）、较高的症状负担（OR 1.99，95% CI 1.49–2.66，P< .0001），以及出院后 7 天内计划外的医疗保健利用（OR 1.85，95% CI，1.29–2.63；P=.001）。高激活组和低激活组术后并发症发生率无差异（OR 1.28，95% CI，0.95–1.73； P=.10）和出院后再次入院（OR 0.95，95% CI，0.30-3.05；P=.93）。我们的结果表明，与高激活度患者相比，低激活度患者延迟出院的风险是高激活度患者的 1.47 倍，术后症状出现的风险几乎是其两倍，以及非计划使用医院服务的风险是其 1.85 倍。术前筛查患者的活动状态不仅可以识别不适合早期出院的患者，更重要的是可以帮助医生和护士制定量身定制的干预措施。