Having Outpatient Major Elective (HOME) Robotic Colon Resection Protocol: A Safe Approach to Ambulatory Colon...

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Enhanced Recovery Pathways

Background:

• Colorectal surgery length of stay has decreased, but same-day discharge remains uncommon.
• Hospital capacity constraints, exacerbated by the COVID pandemic, have delayed colon resections.
• There is a need for protocols enabling ambulatory colon resections to reduce inpatient burden.

Purpose of the Study:

• To develop and evaluate a protocolized enhanced recovery after surgery (ERAS) pathway for ambulatory colon resections.
• To assess the safety and feasibility of same-day discharge after robotic partial colectomy.
• To decrease the overall hospital inpatient burden associated with colorectal procedures.

Main Methods:

• A novel ERAS protocol (HOME protocol) was implemented for same-day discharge.
• Eleven patients underwent robotic partial colectomy and were discharged on the day of surgery.
• Patients were selected based on health status (ASA class 1-2), low follow-up risk, and family support, with daily remote monitoring for 3 days and a 2-week clinic follow-up.

Main Results:

• No readmissions or complications occurred within the 30-day postoperative period for the 11 patients discharged same-day.
• One patient returned to the emergency department for pain management but was not admitted.
• The average operative time for the robotic procedures was 132.1 minutes.

Conclusions:

• A novel ERAS protocol demonstrated the feasibility and safety of ambulatory partial colectomy.
• This approach is suitable for a highly selected patient subset.
• Protocolized same-day discharge can be a safe option for specific colorectal surgery patients.