Safety and Feasibility of a Discharge within 23 Hours after Colorectal Laparoscopic Surgery

Abstract

Background: Enhanced or accelerating recovery programs have significantly reduced hospital length stay after elective colorectal interventions. Our work aims at reporting an initial experience with ambulatory laparoscopic colectomy (ALC) to assess the criteria of discharge and outcomes. Methods: Between 2006 and 2016, data regarding patients having benefited from elective laparoscopic colorectal resections in two main centres in the United Kingdom have been analysed. Both benign and malignant pathologies were included. A standardised enhanced recovery program was performed for each patient, except epidural analgesia was replaced with single shot spinal infiltration. Patients were followed up through a telephone call system by a nurse. Short-term clinical outcomes were analysed. Results: A total of 833 patients were included and 51 (6.1%) were discharged within 24 h following surgery. Of these, 4 out of 51 (7.8%) patients came back hospital within 30 days of discharge; 2 (3.9%) required reoperation (Small bowel obstruction and wound abscess drainage). Conclusions: This study highlights that a 24-h discharge following elective laparoscopic colorectal interventions seems safe and feasible in selected patients. Although challenging to achieve, a standardised approach to laparoscopic surgery in combination with strict adherence to an enhanced recovery protocol are the fundamental elements of this path.

Ambulatory laparoscopic colectomies: a systematic review

“…After full-text reading of 16 eligible articles, a further five were excluded owing to inclusion of patients undergoing robotic-assisted procedures, inability to retrieve patient data or inclusion of data from patients present in more than one study. Eleven studies met the inclusion criteria and were finally selected for the systematic review [5,6,[12][13][14][15][16][17][18][19][20].…”

“…Eight studies [5,6,14,[16][17][18][19][20] were included in the pooled analysis with a total of 1296 patients.…”

“…There was no report of mortality in the reviewed series. Unscheduled consultations occurred in 12% in seven studies [5,6,14,16,[18][19][20] (390 patients).…”

“…Comorbidities and ASA score were used in five studies [5,6,16,18,20] while four studies [5,6,18,19] included age criteria. Patient capability of understanding the ALC protocol was reported in four studies [6,16,18,20]; the access to a telephone was compulsory in three studies [5,18,20], and social circumstances favourable in five [5,6,16,18,20]. Three studies [5,18,20] described as necessary the proximity to the hospital.…”

“…Patient capability of understanding the ALC protocol was reported in four studies [6,16,18,20]; the access to a telephone was compulsory in three studies [5,18,20], and social circumstances favourable in five [5,6,16,18,20]. Three studies [5,18,20] described as necessary the proximity to the hospital. Two articles [6,18] expressly reported excluding all emergency surgeries.…”