Implementation and Evaluation of a Postoperative Virtual Hospital Pathway for Elective Colorectal Surgery: A Propensity-Matched Analysis

Background Virtual Hospital (VH) pathways enable early discharge and are promoted across the NHS. However, evidence supporting their safety, effectiveness, equity, and patient acceptability in elective colorectal surgery remains limited. Objective To evaluate implementation of a VH pathway following elective colorectal surgery and its impact on clinical outcomes, patient-centred recovery, and equality, diversity and inclusion (EDI). Design Retrospective service evaluation with a historical comparator. A 1:1 propensity-matched analysis was performed in colorectal cancer patients using age, sex, body mass index, ASA grade, Charlson Comorbidity Index, procedure type, tumour site, and anastomosis. Setting West Hertfordshire Teaching Hospitals NHS Trust. Patients Patients undergoing elective colorectal surgery between November 2023 and March 2025 managed via a VH pathway, compared with a non-VH cohort. Main outcome measures Primary outcomes were inpatient length of stay (IPLOS), VH length of stay (VHLOS), and days alive and at home within 30 days (DAH30). Secondary outcomes were patient-reported experience and EDI characteristics. Results Eighty-one patients were managed via VH. Median [Q1 - Q3] IPLOS was 2 [1 - 2] days and VHLOS was 2 [2 - 3] days, with no deaths. Forty-two colorectal cancer patients were propensity matched 1:1 to a pre-VH cohort. IPLOS was shorter in the VH cohort (2 [1 - 2] vs 4 [3 - 5] days; p<0.001), and DAH30 was higher (28 [28 - 29] vs 25.5 [24 - 27] days; p<0.0001). Patient experience was positive, with mean satisfaction >8.5/10 and over 90% preferring VH-supported recovery. Sex and ethnicity distributions were similar, although VH patients were younger (p=0.028). Limitations This single-centre retrospective evaluation had a modest sample size and non-randomised design. VH patients were carefully selected, limiting generalisability. Conclusions A VH pathway following elective colorectal surgery is feasible, safe, and acceptable. Compared with a pre-VH cohort, VH care reduced inpatient stay and improved patient-centred recovery without compromising safety.