Feasibility of discharge within 72 hours of major colorectal surgery: lessons learned after 5 years of institutional experience with the ERAS protocol

Abstract

Background Early postoperative discharge after colorectal surgery within the enhanced recovery after surgery (ERAS) guidelines has been demonstrated to be safe, although its applicability has not been universal. The primary aim of this study was to identify the predictors of early discharge and readiness for discharge in a study population. Methods Early discharge was defined as discharge occurring in 72 h or less after surgery. The characteristics and clinical outcomes of the patients in the early and non-early discharge groups were compared, and variables associated with early discharge were identified. Additionally, independent variables associated with the readiness for discharge within 48 h were evaluated. Results Of 965 patients who underwent colorectal surgery between January 2015 and July 2020, 788 were included in this study. No differences in readmission, reoperation, or 30-day mortality were observed between the early and non-early discharge groups. Both early discharge and readiness for discharge had a positive association with adherence to 80 per cent or more of the ERAS items and a negative association with the female sex, duration of surgery, drain positioning, and postoperative complications. Conclusion Early discharge after colorectal surgery is safe and feasible, and is not associated with a high risk of readmission or reoperation. Discharge at 48 h can be reliably predicted in a subset of patients. Future studies should collect prospective data on early discharge related to safety, as well as patients’ expectations, possible organizational issues, and effective costs reduction in Italian clinical practice.

Incidence and clinical predictors of 30‐day emergency readmission after colorectal cancer surgery – A nationwide cohort study

“…LOS may be a surrogate marker for both illness severity and occurrence of in‐hospital postoperative complications. The introduction of the Enhanced Recovery After Surgery (ERAS) protocol has markedly reduced LOS after surgery, and studies report that discharge after 48–72 h is safe and feasible in an ERAS setting [5, 32]. One study on US Medicare data, however, reported an increased risk of readmission in hospitals with LOS ≤ 4 days [33].…”

The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery

“…However, these conditions may only be met 1-2 days post-surgery. In a study of 788 ERAS colorectal surgical patients, Biondi et al [28] compared 146 (18.5%) who were discharged within 72 hours post-surgery to the remaining patients. They reported that over 80% adherence to ERAS was a positive factor for early discharge.…”