Factors associated with admission before the day of elective major surgery: an analysis of the UK’s Perioperative Quality Improvement Programme

NHS hospitals face daily challenges with limited bed capacity. One way to ease pressure is to avoid admitting patients earlier than necessary before planned (elective) surgery. Early admissions can increase bed use, costs, and patient disruption without always improving safety.

This study analysed data from over 54,000 patients across NHS hospitals who had major elective surgery. It looked at which factors were linked to being admitted before the day of surgery, as well as to longer recovery stays in hospital afterwards.

The study found that 16% of patients were admitted early. Key reasons included:
 

• living far from the hospital,

• certain types of surgery,

• abnormal test results before surgery,

• frailty or poorly controlled diabetes,

• needing bowel preparation,

• or not completing a pre-surgery assessment.

While many clinical factors influenced how long patients stayed in hospital after surgery, distance from home played only a small role. Importantly, the research showed that differences between hospitals themselves—such as local policies or culture—also strongly influenced whether patients were admitted before the day of surgery.

These findings suggest that better pre-surgery planning and hospital practices could safely reduce unnecessary early admissions, helping to free up beds and improve patient experience.

Lead Investigator