Feasibility assessment of outpatient colorectal resections at a tertiary referral center
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ORIGINAL ARTICLE
Feasibility assessment of outpatient colorectal resections at a tertiary referral center Adam Studniarek 1 & Daniel J. Borsuk 1 & Kunal Kochar 1,2 & John J. Park 1 & Slawomir J. Marecik 1,2 Accepted: 9 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Enhanced Recovery After Surgery (ERAS) protocols, particularly when paired with advanced laparoscopy, have reduced recovery time following colorectal procedures. The aim of this study was to determine if length of stay (LOS) could be reduced to an overnight observation stay (< 24 h) with comparable perioperative morbidity. The secondary aim was to establish predictive factors contributing to early discharge. Methods This is a retrospective cohort study of all colectomies at a tertiary care center between January 2016 and January 2019. Inclusion criteria included all colorectal resections with varying surgical approaches. Patients underwent a standardized ERAS protocol. A logistical regression model was conducted for predictive factors. Results Three hundred sixty patients were included (55.3% female). Of these, 78 (21.7%) patients were discharged within < 24 h and 112 (31.1%) were discharged within 24–48 h. The remainder comprised the > 48 h group. Age differed significantly between the < 24 h and 24–48 h groups (p < 0.0001). Patients discharged within 24 h were younger (59.4 ± 12.3 years), had a lower CCI score (3.1; p = 0.0026), and lower ASA class (p < 0.0001). Emergency department visits (p = 0.3329) and readmissions (p = 0.6453) prior to POD 30 remained comparable among all groups. Younger age, low ASA, and minimally invasive surgical approach all contributed to ultra-fast discharge. Conclusion ERAS protocols may allow for discharge within 24 h following a major colorectal resection, all with low perioperative morbidity and mortality. The predictive factors for discharge within 24 h include a low ASA (I or II), and a minimally invasive surgical approach. Keywords ERAS . Colectomy . Rectal . Resection . Overnight observation . Multimodal analgesia . Short LOS
Introduction Over the past decade, Enhanced Recovery After Surgery (ERAS) protocols have been implemented across institutions worldwide [1]. The advantages offered by laparoscopic and robotic surgery, multimodal analgesia, and ERAS protocols allow surgeons to push the lower limits for hospital length of stay (LOS) following a major abdominal surgery [2]. This Meeting presentation: SP115 E-Poster, October 28th, 2019, ACS Clinical Congress, San Francisco, CA, USA * Slawomir J. Marecik [email protected] 1
Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL 60068, USA
2
Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
poses the question for colorectal surgeons as to whether it is safe to discharge patients within 24 h (outpatient status). From a financial standpoint, hospital stays following colorectal resections constitute a large perc
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