Development of criteria-led discharge for patients undergoing abdominal wall reconstruction

Despite the wide adoption of Enhanced Recovery After Surgery (ERAS) protocols, no formal discharge criteria have been validated for patients undergoing abdominal wall reconstruction (AWR). This study evaluates the validity and utility of a 15-item discharge checklist following AWR. We retrospectively reviewed 128 consecutive adult patients who underwent elective open AWR by a single surgeon between 2021 and 2023, and a 15-item binary checklist was applied. Criteria validity was assessed by concordance with discharge decisions, while utility was evaluated using 30-day complication rates and hospital length of stay (LOS). Multivariate logistic regression was conducted before and after propensity adjusting for age, patient comorbidities and procedure complexities. Of 128 patients, 67 (52.3%) met all 15 checklist criteria on the day of discharge, while 61 (47.7%) did not. Those who met full criteria had significantly shorter LOS (4.0 vs. 5.8 days; p < 0.001), lower 30-day complication rates (15.6% vs. 52.6%; p = 0.006) and a lower rate of 30-day readmission (1.5% vs. 11.5%, p = 0.027) compared to those who did not. The checklist had a sensitivity of 80.9% and specificity of 56.3% for predicting uneventful discharge. Meeting all 15 checklist criteria was associated with lower odds of 30-day complication requiring intervention [adjusted odd ratio aOR) 0.12 (0.04–0.41) p < 0.001 and 30-day readmission [aOR 0.12 (0.02–0.79) P = 0.027]. A structured 15-item checklist is clinically valid, accurately identifies patients safe for discharge after open AWR, can reduce LOS, and predict postoperative complications. These findings support checklist-guided, criteria-led discharge as a valuable adjunct to ERAS protocols in AWR.