Is Same-Day and Next-Day Discharge After Laparoscopic Colectomy Reasonable in Select Patients?

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

doi:10.1097/dcr.0000000000001729

Cited by 35 publications

(47 citation statements)

References 15 publications

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“…From our experience and previously published data, we know that SDD after colectomy is a safe and feasible option in the proper patient population [ 7 – 11 ]. As clinicians pressured by constraints of the current COVID 19 pandemic, we have viewed upgrading our ERAS protocols into SDD regimens as a success.…”

Section: Discussionmentioning

confidence: 95%

“…With SDD being in its infancy, the robust review of both clinical data and the patient perspective has been limited. We have found few studies reporting clinical SDD outcomes and no studies focusing on the patient perception of SDD [7][8][9][10][11]. Through our survey, we identified many factors that patients found beneficial in their experience.…”

Section: Table 1 Comparison Of Average Responses To Numerical Based S...mentioning

confidence: 99%

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The patient perspective of same day discharge colectomy: one hundred patients surveyed on their experience following colon surgery

et al. 2022

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Section: Discussionmentioning

confidence: 95%

Section: Table 1 Comparison Of Average Responses To Numerical Based S...mentioning

confidence: 99%

The patient perspective of same day discharge colectomy: one hundred patients surveyed on their experience following colon surgery

et al. 2022

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“…Two percent of the early discharge group (POD 0–1) required early readmission, most commonly due to ileus/obstruction (41%). There were equivalent rates of anastomotic leak, ileus and readmission between all discharge groups 14. A study of 37 patients discharged on the day of surgery following laparoscopic colectomy or loop ileostomy reversal reported a 17% complication rate and 6% readmission rate, compared to 15% and 4%, in their standard ERAS group, respectively 15…”

Section: Discussionmentioning

confidence: 96%

“…There were equivalent rates of anastomotic leak, ileus and readmission between all discharge groups. 14 A study of 37 patients discharged on the day of surgery following laparoscopic colectomy or loop ileostomy reversal reported a 17% complication rate and 6% readmission rate, compared to 15% and 4%, in their standard ERAS group, respectively. 15 In terms of the timing of discharge, our study differs in some characteristics from the previous reports relating to ambulatory surgery from the Centers in France and the UK.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Ambulatory Surgery as the Next Management Paradigm in Colorectal Resection Surgery

et al. 2022

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Background: Current clinical dogma favors universal inpatient admission after colorectal resection particularly in the presence of an anastomosis. Objective: We evaluate the feasibility and safety of ambulatory surgery in carefully selected patients undergoing colorectal resection/anastomosis. Methods: Between October 2020 and October 2021, all patients undergoing colorectal resection/anastomosis meeting specific criteria {no major comorbidity [American Society of Anesthesiologist (ASA) <4], not on therapeutic anticoagulation, compliant patient/family} were counseled preoperatively for ambulatory surgery (discharge <24 h postsurgery). Complicated surgery (ileoanal pouch, enterocutaneous fistula repair, reoperative pelvic surgery, multiple resections) and/or ostomy creation (loop/end ileostomy, Hartmann’s, abdominoperineal resection) were exclusions. Discharge was at 6 to 8 hours postoperatively if all predetermined factors (no ostomy teaching needed, ambulating comfortably, tolerating diet, stable vitals, and blood-work) were met and patients were willing, or was postponed to the next day at patient request. All discharged patients received phone checks the next day with the option also given for voluntary readmission if inpatient care was preferred by patient. Patients discharged <24 hours postop (AmbC) were compared to those staying on as inpatients admitted (InpC) and also to a comparable historical (October 2019–October 2020) group when ambulatory surgery was not offered (HistC). Results: Of 184 abdominal colorectal surgery patients, 97 had complicated colorectal resection and/or ostomy. Of the remaining 87, 29 (33.3%) were discharged <24 hours postoperatively [7 (24%) patients at 8 h]. Of these 29 AmbC patients, 4 were readmitted <30 days (ileus: 1, rectal bleeding: 2, nausea/vomiting: 1), 1 readmission was on first postdischarge day, none were voluntary post phone-check. AmbC and InpC (n=58) had similar age, sex, race, body mass index, and comorbidity. InpC had greater estimated blood loss (109 vs 34 mL, P<0.001) while length of stay was expectedly significantly longer (109 vs 17 hours, P<0.001). There was no mortality in either group. AmbC and InpC had similar readmission, reoperation, anastomotic leak, ileus, and surgical site infection. Mean length of stay for HistC was 83 hours. AmbC and HistC had similar age, sex, race, body mass index, and ASA class. Complications including readmission, reoperation, anastomotic leak, ileus, and surgical site infection were also similar for AmbC and HistC. Conclusions: With careful patient selection, preoperative education, perioperative management, and postoperative follow-up, ambulatory surgery is feasible in up to a third of patients undergoing colorectal resection/anastomosis and can be performed with comparable safety to the time-honored practice of routine inpatient hospitalization. Refinements in inclusion/exclusion criteria and postoperative outpatient follow-up will allow a paradigm shift in how such patients are managed, which has huge implications f...

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“…Healthy patients, with minimal comorbidities, have been discharged on the same day or the next day after laparoscopic colorectal surgery [ 23 ] and this requires very early mobilization. For increased same day pathways, a requirement would consequently seem be an immediate mobilization in the PACU since it is feasible and safe.…”

Section: Discussionmentioning

confidence: 99%

Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

et al. 2021

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Background Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach. Methods This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space. Results In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred. Conclusions Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

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Is Same-Day and Next-Day Discharge After Laparoscopic Colectomy Reasonable in Select Patients?

Cited by 35 publications

References 15 publications

The patient perspective of same day discharge colectomy: one hundred patients surveyed on their experience following colon surgery

The patient perspective of same day discharge colectomy: one hundred patients surveyed on their experience following colon surgery

Feasibility and Safety of Ambulatory Surgery as the Next Management Paradigm in Colorectal Resection Surgery

Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

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