Early discharge after colorectal cancer resection: trends and impact on patient outcomes

Moon, Jeongyoon; Pang, Allison; Ghitulescu, Gabriela; Faria, Julio; Morin, Nancy; Vasilevsky, Carol‐Ann; Boutros, Marylise

doi:10.1007/s00464-021-08923-y

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…In agreement with our findings, prior studies of patients undergoing coronary artery bypass grafting and anatomic lung resection have noted cost-savings between $3,000 and $5,000 among those discharged early [7,8]. Moon et al analyzed the 2011-2017 NRD and found expedited discharge following colorectal resection to be associated with reduced costs at the index admission but greater costs upon rehospitalization [4]. In contrast, our analysis found no difference in the cost of readmission.…”

Section: Plos Onesupporting

confidence: 91%

“…Records with missing data for age, sex, length of stay (LOS) and costs were excluded (<1%). Based on previously published thresholds, patients were stratified a priori into Early (LOS�3 days) and Routine (LOS>4 days) cohorts [4,11,12]. Derivation of the study population is shown in Fig 1.…”

Section: Methodsmentioning

confidence: 99%

“…Of note, advances in chemotherapeutic agents, surgical technique and perioperative care have contributed to declining mortality, complications and length of stay following colectomy for cancer [3]. However, hospitalization costs and unplanned readmission rates remain high and rising [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Early discharge following colectomy for colon cancer: A national perspective

Verma,

Bakhtiyar,

Ali

et al. 2024

PLoS ONE

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Background Although early discharge after colectomy has garnered significant interest, contemporary, large-scale analyses are lacking. Objective The present study utilized a national cohort of patients undergoing colectomy to examine costs and readmissions following early discharge. Methods All adults undergoing elective colectomy for primary colon cancer were identified in the 2016–2019 Nationwide Readmissions Database. Patients with perioperative complications or prolonged length of stay (>8 days) were excluded to enhance cohort homogeneity. Patients discharged by postoperative day 3 were classified as Early, and others as Routine. Entropy balancing and multivariable regression were used to assess the risk-adjusted association of early discharge with costs and non-elective readmissions. Importantly, we compared 90-day stroke rates to examine whether our results were influenced by preferential early discharge of healthier patients. Results Of an estimated 153,996 patients, 45.5% comprised the Early cohort. Compared to Routine, the Early cohort was younger and more commonly male. Patients in the Early group more commonly underwent left-sided colectomy and laparoscopic operations. Following multivariable adjustment, expedited discharge was associated with a $4,500 reduction in costs as well as lower 30-day (adjusted odds ratio [AOR] 0.74, p<0.001) and 90-day non-elective readmissions (AOR 0.74, p<0.001). However, among those readmitted within 90 days, Early patients were more commonly readmitted for gastrointestinal conditions (45.8 vs 36.4%, p<0.001). Importantly, both cohorts had comparable 90-day stroke rates (2.2 vs 2.1%, p = 0.80). Conclusions The present work represents the largest analysis of early discharge following colectomy for cancer and supports its relative safety and cost-effectiveness.

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Section: Plos Onesupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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Early discharge following colectomy for colon cancer: A national perspective

Verma,

Bakhtiyar,

Ali

et al. 2024

PLoS ONE

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“…First, our study extends the data period to 2021, offering a more contemporary dataset than any of the three aforementioned studies. (19,34,35) Given the acceleration of ERAS initiatives around the country during this time, including proposals for same-day discharge, as well as the heightened pressure to reduce LOS in the wake of the COVID-19 pandemic, we believe these more recent years add new value to this topic of study. Additionally, Balas et al did not examine readmission as a discrete outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Bounceback readmission was de ned as any readmission occurring ≤ 7 days from the discharge date. (19) Postdischarge complication rate was calculated using the variables within the ACS-NSQIP database that speci ed the timing of a given complication. Of note, these variables were only available for select complications (organ space SSI, pneumonia, unplanned intubation, pulmonary embolism, on ventilator > 48 hours, stroke/cva, cardiac arrest, MI, DVT, sepsis, and septic shock).…”

Section: Methodsmentioning

confidence: 99%

Association of Robotic Surgery with Early Discharge, Readmission, and Complications in Elective Colectomy: An Analysis of NSQIP Data from 2012-2021

Hsu,

Zion,

Powell

et al. 2024

Preprint

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Background: Early discharge (ED) after colectomy has become a target outcome for multiple reasons, but the factors associated with ED are not well characterized. This study investigated the factors associated with ED and evaluated the impact of ED on overall outcome. Methods: Data from ACS-NSQIP were used to identify patients who underwent non-emergent colectomy from 2012 to 2021. ED was defined as length of stay ≤2 days. Unpaired t-tests, chi-square tests and adjusted multivariate logistic regression modeling were used to estimate associated factors for ED. Bounceback readmission was defined as readmission within 7 days of discharge. Results: In this cohort of 282,490 patients, 43,137 (15.3%) met the criteria for ED. Robotic colectomy (OR 14.35; 95%CI [13.63-15.12]) was more strongly associated with ED than any other patient characteristic, including laparoscopic colectomy (6.82 [6.51-7.14], ref open colectomy). ED vs. non-ED patients had lower rates of 30-day (5.84 vs. 10.37%, P<0.01) and bounceback (3.56 vs. 5.75%, P<0.01) readmissions, overall complications (5.65 vs. 18.63%, P<0.01) and post-discharge complications (4.21 vs. 7.49%, P<0.01). Conclusions: Robotic surgery was the variable most strongly associated with ED, and had twice the odds of ED compared to laparoscopic colectomy. Patients who had ED after robotic surgery had lower rates of complications and readmission compared to non-ED patients.

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