Percentage agreement, mean and range of Likert scale scores in Rounds 2 and 3
Round 2 Round 3
Agreement (% of agree Mean Likert scale Agreement (% of agree Mean Likert sc
or strongly agree) score (range) or strongly agree) score (range
Tolerance of oral intake 100* 4.8 (4 – 5) 100* 4.8 (4 – 5)
Patient should drink liquids actively (ideally > 800-1000 ml/day) without nausea, vomiting, bloating or worsening abdominal pain.
Intravenous fluids infusion should not be required to maintain hydration. Tolerance of solid food is desirable but absence of 53 3.5 (1 – 5) 73 4 (2 – 5)
appetite for solids should not preclude discharge
Patient is able to tolerate at least one solid meal without nausea, vomiting, bloating or worsening abdominal pain. Patient should
73* 4.0 (3 – 5) 93* 4.3 (2 – 5)
drink liquids actively (ideally > 800-1000 ml/day) and do not require intravenous fluids infusion to maintain hydration
Patient is able to tolerate at least two solid meals without nausea, vomiting, bloating or worsening abdominal pain. Patient should
33 3.0 (2 – 5) 13 2.3 (1 – 4)
drink liquids actively (ideally > 800-1000 ml/day) and not require intravenous fluids infusion to maintain hydration
Patient should be able to consume at least 60% of protein/energy daily requirement by solid food or in combination with oral
nutritional supplements. Patient should drink liquids actively (ideally > 800-1000 ml/day) and not require intravenous fluids 40 3.0 (1 – 5) 20 2.6 (1 – 4)
infusion to maintain hydration
Recovery of lower gastrointestinal function 100* 4.5 (4 – 5) 100* 4.7 (4 – 5)
Patient should have some kind of evidence of resumed gut function: passage of flatus or a bowel motion, or tolerance of oral intake
without bloating or worsening abdominal pain. Passage of flatus or bowel motion is desirable but absence should not preclude 47 3.2 (1 – 5) 53 3.7 (2 – 5)
discharge
Patient should have passed flatus or a bowel motion 67 3.8 (2 – 5) 73 4.0 (2 – 5)
Patient should have passed flatus 67 3.9 (2 – 5) 80* 4.0 (2 – 5)
Patient should have passed a bowel motion 27 2.8 (2 – 5) 33 2.8 (2 – 4)
Patient should have passed flatus and a bowel motion 13 2.4 (1 – 5) 7 2.1 (1 – 4)
Adequate pain control with oral analgesia 100* 4.8 (4 – 5) 93* 4.7 (4 – 5)
Patient should be able to rest and mobilize (sit up and walk, unless unable preoperatively) without significant pain (i.e. patient
60 3.7 (2 – 5) 40 3.2 (1 – 5)
reports pain is controlled or pain score < 4 on a scale from 0 to 10) while taking oral non-opioid analgesics
Patient should be able to rest and mobilize (sit up and walk, unless unable preoperatively) without significant pain (i.e. patient
93* 4.4 (3 – 5) 80* 4.4 (3 – 5)
reports pain is controlled or pain score < 4 on a scale from 0 to 10) while taking oral analgesics
Ability to mobilize and self-care 100* 4.5 (4 – 5) 100* 4.6 (4 – 5)
Patient should be able to sit up, walk and perform activities of daily living (e.g. go to the toilet, dress, shower and climb stairs if
93* 4.4 (3 – 5) 93* 4.5 (4 – 5)
needed at home) unless unable preoperatively
Patient should be able to stay in bed less than 3 hours during daytime and perform activities of daily living (e.g. go to the toilet,
27 2.9 (2 – 4) 20 2.8 (2 – 5)
dress, shower and climb stairs if needed at home) unless unable preoperatively
Patient should be able to walk >25 meters unaided, perform activities of daily living (e.g. go to the toilet, dress, shower and climb
20 2.9 (2 – 5) 33 3.0 (1 – 5)
stairs if needed at home) unless unable preoperatively
Percentage agreement, mean and range of Likert scale scores in Rounds 2 and 3 (cont.)
Round 2 Round 3
Agreement (% of agree Mean Likert scale Agreement (% of agree Mean Likert sc
or strongly agree) score (range) or strongly agree) score (range
Clinical examination and laboratory tests show no evidence of complications or untreated medical problems 87* 4.5 (3 – 5) 100* 4.5 (4 – 5)
Oral temperature should be normal 87* 4.4 (2 – 5) 80* 4.3 (3 – 5)
Pulse, blood pressure and respiratory rate are stable and consistent with preoperative levels 93* 4.4 (3 – 5) 100* 4.5 (4 – 5)
White blood cells count should be normal, close to normal or trending to improvement 67 3.6 (1 – 5) 67 3.6 (2 -5)
Serum hemoglobin concentration is stable, within acceptable levels ** - - 87* 4.1 (2 – 5)
There should be no rectal bleeding 60 3.6 (2 – 5) 53 3.5 (2 – 5)
There should be no calf swelling or tenderness 67 4.0 (2 – 5) 67 3.7 (2 – 5)
Surgical wounds should not have purulent discharge 53 3.7 (2 – 5) 53 3.4 (2 – 5)
Patient is able to empty the bladder without difficulty or match preoperative level of bladder function 87* 4.1 (2 – 5) 100* 3.5 (4 – 5)
If the patient had a stoma constructed, output should be low (ideally < 1000 ml/day) 60 3.5 (2 – 5) 73 3.9 (2 – 5)
When the criteria described above are fulfilled, the patient is considered to have reached short-term postoperative recovery and
should be considered ready for discharge. Discharge may take place as soon as:
Patient has adequate post-discharge support (family at home, nursing or rehabilitation facility) 100* 4.4 (4 – 5) 100* 4.5 (4 – 5)
Patient is willing to leave hospital 67 3.8 (2 – 5) 80* 4.0 (2 – 5)
Patient is able to return to a follow up visit as an outpatient 53 3.4 (2 – 5) 47 3.2 (1 – 5)
There is transport available 60 3.4 (1 – 5) 47 3.2 (2 – 5)
If the patient had a stoma constructed, he or his family received training on stoma care or outpatient training has been arranged 67 3.8 (2 – 5) 87* 4.3 (2 – 5)
* Consensus achieved (i.e. >75% of the experts agree or strongly agree)
** Endpoint included after Round 2.
