Details

Autor(en) / Beteiligte

• Robitaille, Stephan
• Wang, Anna
• Liberman, Sender
• Charlebois, Patrick
• Stein, Barry
• Fiore, Julio F
• Feldman, Liane
• Lee, Lawrence

Titel

Feasibility of expanding an ambulatory colectomy protocol: a retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway

Ist Teil von

• Canadian Journal of Surgery, 2022-11, Vol.65, p.S71-S71

Ort / Verlag

Ottawa: CMA Impact, Inc

Erscheinungsjahr

2022

Link zum Volltext

Quelle

Nexis Uni

Beschreibungen/Notizen

• Background: There is increasing evidence to support discharge before gastrointestinal recovery following colorectal surgery. Furthermore, many patients are discharged early despite being excluded from an ambulatory colectomy pathway. The objective of this study was to determine the outcomes of patients discharged early following laparoscopic colectomy in an enhanced recovery pathway (ERP). Methods: A retrospective review of all adult patients undergoing elective laparoscopic colectomy at a single university-affiliated colorectal referral centre (August 2017 to June 2021) was performed. Patients were included if they had undergone elective laparoscopic colectomy or ileostomy closure and excluded if they had been enrolled in an ambulatory colectomy pathway. Patients were then divided into 3 groups: length of stay (LOS) 1 day, LOS 2-3 days, and LOS ≥ 4 days. The main outcomes were 30-day emergency department (ED) visits, and readmissions. Reasons for inpatient stay per postoperative day (POD) were also recorded. Results: A total of 497 patients were included (LOS 1: n = 63, 13%; LOS 2-3: n = 284, 57%; LOS > 4: n = 150, 30%). There were no differences in patient characteristics, diagnosis, or procedure between the groups. Patients were discharged with gastrointestinal recovery (GI-3) in 54% LOS 1 v. 98% LOS 2-3 v. 100% LOS ≥ 4 (p < 0.001). Shorter procedure duration, transversus abdominus plane block, and lower opioid requirements were associated with shorter LOS (p < 0.001). Absence of flatus was the most common reason to keep patients hospitalized: 61% on POD 1, 21% on POD 2, and 8% on POD 3 (p < 0.001). There were no differences in 30-day ED visits or readmission between the groups. In the LOS 1 group, there were no differences in outcomes between patients with full return of bowel function at discharge compared with those without. Conclusion: Discharge on POD 1 was not associated with increased ED use, complications or readmissions. Importantly, full return of bowel function at discharge did not affect outcomes. There may be potential to expand eligibility criteria for ambulatory colectomy protocol.