Is same-day and next-day discharge after laparoscopic colectomy reasonable in select patients?xs

Nicholas P. McKenna, Katherine A. Bews, Omair A. Shariq, Elizabeth B. Habermann, Kevin T. Behm, Scott R. Kelley, David W. Larson

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Discharge on postoperative day 3 after laparoscopic colorectal resections is now common, and same-day discharge has been proposed recently as an option. OBJECTIVE: The purpose of this study was to determine the safety of same-day and next-day discharge after laparoscopic colorectal surgery and to delineate which characteristics may make a patient eligible for this pathway. DESIGN: This was a retrospective cohort study. SETTINGS: The American College of Surgeons National Surgical Quality Improvement Project Targeted Colectomy Participant User File was used. PATIENTS: Patients underwent elective laparoscopic colorectal resection and were discharged without complications on or before postoperative day 5 (early discharge: postoperative day 0 or 1, intermediate: postoperative day 2, standard: postoperative day 3 to 5). MAIN OUTCOME MEASURES: Early readmission (on or before postoperative day 7), anastomotic leak, ileus, and overall readmission were measured. RESULTS: Of 36,526 patients total, 906 (2.5%) were discharged on postoperative day 0 or 1. Patients discharged on postoperative day 0/1 tended to have shorter-duration operations, a diagnostic indication more commonly of benign neoplasm, and underwent less low pelvic anastomoses. The readmission rate within 7 days was only 2%. Overall rates of anastomotic leak (0.6% early, 1.0% intermediate, 1.2% standard), ileus (1.9% early, 1.5% intermediate, 2.1% standard), and readmission (early 4.8%, intermediate 5.1%, standard 5.8%) were equivalent to decreased in patients discharged early versus those discharged in the intermediate or standard discharge groups. On multivariable analysis, dismissal day remained a noncontributory-to-protective factor against anastomotic leak, ileus, and readmission. LIMITATIONS: Specific follow-up pathways used were unknown, and selection bias exists in deciding what day patients can be discharged. CONCLUSIONS: Discharge on the same day or next day after surgery was not associated with increased risk compared with discharge on postoperative day 3 to 5, and it did not result in a high rate of early readmissions. Increased use of expedited discharge pathways would reduce hospital costs and resource use. See Video Abstract at http://links.lww.com/DCR/B331.

Original languageEnglish (US)
Pages (from-to)1427-1435
Number of pages9
JournalDiseases of the colon and rectum
DOIs
StateAccepted/In press - 2020

Keywords

  • Enhanced recovery after surgery
  • Laparoscopy
  • Outpatient surgery
  • Same-day discharge

ASJC Scopus subject areas

  • Gastroenterology

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