To address this gap in knowledge and practice, an 11-member expert panel was convened to identify signs and symptoms that patients should report following colorectal surgery. The panel used a standardized Delphi process to reach a national consensus, which was defined as the point when at least 70% of the experts rated a symptom as 4 or more on a 5-point Likert scale (e.g. agree or strongly agree).
The expert panel members identified 10 signs and symptoms that patients should immediately report if they occur following colorectal surgery. They include wound drainage, wound opening, wound redness or changes in the skin around the wound, no bowel movement or lack of gas/stool from an ostomy for more than 24 hours, increasing abdominal pain, vomiting, abdominal swelling, high ostomy output and/or dark urine or no urine, fever greater than 101.5°F, and not being able to take anything by mouth for more than 24 hours. Two additional symptoms that require patients to seek emergency care shortness of breath or inability to breathe and chest pain. The expert panel hopes that this list will be used in clinical practice to guide discharge instructions for patients post colorectal surgery. This process also can be used to identify specific discharge instructions following other types of surgery.