Ambulatory colectomy: a pathway for advancing the enhanced recovery protocol

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Minimally Invasive Surgery

Background:

• Enhanced Recovery After Surgery (ERAS) protocols optimize surgical recovery by reducing stress and length of stay.
• ERAS guidelines have evolved, prompting investigation into further improvements in patient recovery.
• Minimally invasive surgery (MIS) has advanced surgical techniques, creating opportunities for same-day discharge.

Purpose of the Study:

• To describe and evaluate the feasibility of same-day discharge (SDD) colectomy as a progression of ERAS protocols.
• To identify patient selection criteria and procedural elements enabling SDD for colectomy patients.
• To assess the safety and complication rates associated with SDD colectomy.

Main Methods:

• Retrospective review of colectomy procedures performed between February 2019 and January 2022.
• Defined Same Day Discharge (SDD) as admission less than 23 hours with no overnight stay.
• Included non-emergent, MIS colectomies, with patient selection based on comorbidities, social support, and communication means, alongside strict intraoperative and postoperative criteria.

Main Results:

• Out of 326 total colectomies, 115 patients (35.3%) met criteria for SDD.
• The most common procedures were low anterior resection (53.0%) and right hemicolectomy (21.7%).
• Only 5 patients (4.3%) returned to the emergency department, with just 1 (0.9%) requiring readmission.

Conclusions:

• Same-day discharge colectomy is a safe advancement of ERAS protocols for carefully selected patients.
• Strict patient selection, intraoperative management, and postoperative monitoring are crucial for successful SDD.
• SDD colectomy demonstrates a low complication and readmission rate, enhancing recovery pathways.