Evidence map›Paper›PMID 33199451›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2020

Delayed discharge after major surgical procedures in Ontario, Canada: a population-based cohort study.

Angela Jerath, Jason Sutherland, Peter C Austin, Dennis T Ko, Harindra C Wijeysundera, Stephen Fremes, Paul Karanicolas, Daniel McCormack, Duminda N Wijeysundera

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
0.9field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 19 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
  4. Healthcare Priorities for Surgical Care in Canada.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025
    Review
  5. Alternate Level of Care Patients in Canada: a Scoping Review.Canadian geriatrics journal : CGJ · 2024
    Article
  6. Article
  7. Article
  8. Survival and health care costs after inpatient elective surgery: comparison of patients with and without chronic obstructive pulmonary disease.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023
    Article
  9. The authors respond to: "Delayed discharge and frailty, delirium and functional decline".CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021
    Article
  10. Delayed discharge and frailty, delirium and functional decline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Angela JerathSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont. Angela.Jerath@mail.utoronto.ca.
Jason SutherlandSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Peter C AustinSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Dennis T KoSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Harindra C WijeysunderaSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Stephen FremesSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Paul KaranicolasSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Daniel McCormackSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Duminda N WijeysunderaSunnybrook Research Institute (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas), Division of Cardiology (Ko, H. Wijeysundera), Division of Cardiac Surgery (Fremes) and Department of General Surgery (Karanicolas), Sunnybrook Health Sciences Centre; Department of Anesthesia and Pain Medicine (Jerath, D. Wijeysundera), University of Toronto; ICES Central (Jerath, Austin, Ko, H. Wijeysundera, Fremes, Karanicolas, McCormack, D. Wijeysundera), Toronto, Ont.; School of Population and Public Health (Sutherland), University of British Columbia, Vancouver, BC; Li Ka Shing Knowledge Institute (D. Wijeysundera), St. Michael's Hospital, Toronto, Ont.
Sunnybrook Health Science Centre · CASunnybrook Research InstituteUniversity of British Columbia · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAddressing nonmedical reasons for delays in hospital discharge is important for improving the flow of patients through acute care hospital beds. Because this problem is understudied among adult surgical patients, we examined the incidence of and identified factors associated with delayed hospital discharge after major elective and emergency surgical procedures in acute care institutions.

methodsUsing health administrative data, we retrospectively compared adults with and without delayed discharge after 18 major elective and emergency surgical procedures between 2006 and 2016 in Ontario hospitals. We identified delayed discharge using the alternate level of care code, applied to patients who are medically fit for discharge but remain in an acute care hospital bed. We used hierarchical logistic regression modelling to determine factors associated with delayed discharge.

resultsOur cohort included 595 782 patients who underwent elective procedures and 180 478 who underwent emergency procedures. Delayed discharge accounted for 635 607 hospital days, of which 81.7% were related to admissions for emergency surgery. Delayed discharge affected 3.1% of patients who underwent elective surgery and 19.6% of those who underwent emergency procedures. Days attributed to delayed discharge formed about one-third of patients' total hospital stay for both surgical groups. The rate of delayed discharge across surgical specialties showed high variability (from 0.9% for lung resection or nephrectomy to 9.3% for peripheral arterial disease procedures in the elective surgery group, and from 3.8% for cardiac procedures to 33.8% for peripheral arterial disease procedures in the emergency surgery group). Risk factors for delayed discharge were older age, female sex, chronic disease burden and increasing hospital size.

interpretationDelayed discharge for nonmedical reasons was more common after emergency surgery than after elective surgery, and rates varied across surgery type. Optimizing early discharge planning, evaluating the variation in delayed discharge at the hospital level and improving local access to community care services could be next steps to addressing this problem.

Indexed as

Elective Surgical ProceduresEmergency Service, HospitalAgedAged, 80 and overAnimalsCohort StudiesDatabases, FactualHumansLength of StayMaleOntarioPatient DischargeRabbitsRetrospective Studies

Identifiers

PMID33199451
PMCPMC7683004
OpenAlexW3097989175

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.