When are concerted reforms feasible?: Explaining the emergence of social pacts in Western Europe.

Under what conditions do governments, employers, and unions enter formal policy agreements on incomes, employment, and social security? Such agreements, widely known as social pacts, became particularly prominent during the 1990s when European economies underwent major adjustment. This article seeks to explain national variation in adjustment strategies and specifically why concerted agreements were struck in some countries but not in others. A fuzzy-set qualitative comparative analysis of 14 European countries is employed to assess main arguments about the emergence of pacts. The analysis yields two key findings. First, although prevailing arguments emphasize Economic and Monetary Unionrelated pressures, or alternatively unemployment, these factors were neither necessary nor in themselves sufficient for pacts to materialize. Rather, a high economic problem load appears to be causally relevant only when combined with particular political and institutional conditions, namely, the prevalence of electorally weak governments and/or an intermediate level of union centralization. Second, the analysis refines existing multicausal explanations of pacts by demonstrating three distinct, theoretically and empirically relevant causal pathways to concerted agreements

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien\u2013Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9\ub72 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4\u20137) and 7 (6\u20138) days respectively (P < 0\ub7001). There were no significant differences in rates of readmission between these groups (6\ub76 versus 8\ub70 per cent; P = 0\ub7499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0\ub790, 95 per cent c.i. 0\ub755 to 1\ub746; P = 0\ub7659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34\ub77 versus 39\ub75 per cent; major 3\ub73 versus 3\ub74 per cent; P = 0\ub7110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients