Early discharge and readmission after colorectal resection

Area of Science:

• Surgical Outcomes Research
• Health Services Research
• Colorectal Surgery

Background:

• Healthcare systems increasingly focus on cost-effectiveness and quality.
• Efforts are underway to reduce postoperative length of stay while maintaining low 30-day readmission rates.
• This study investigates early discharge (ED) in colorectal surgery patients.

Purpose of the Study:

• Identify factors associated with early discharge after colorectal resection.
• Evaluate the impact of early discharge on 30-day readmission rates.

Main Methods:

• Analysis of 28,532 patients undergoing colorectal resection from the 2011 American College of Surgeons National Surgical Quality Improvement Program Participant Use File.
• Early discharge defined as length of stay within the 25th percentile for specific procedures (rectal resection, open colectomy, laparoscopic colectomy).
• Multivariate logistic regression used to identify predictors of early discharge and readmission.

Main Results:

• Early discharge occurred in 7% (rectal), 52% (open colectomy), and 40% (laparoscopic colectomy) of patients by postoperative days 5, 5, and 3, respectively.
• Factors associated with reduced likelihood of early discharge included older age, steroid use, ostomy creation, nonelective surgery, and postoperative complications.
• The overall readmission rate was 12%, with significantly lower readmission rates observed in patients discharged early (OR, 0.77; 95% CI, 0.70-0.84).

Conclusions:

• Early discharge is feasible in selected colorectal surgery patients.
• Implementing early discharge strategies can be achieved without negatively impacting readmission rates.
• This approach supports high-quality, cost-effective healthcare delivery in colorectal surgery.