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Early Discharge after Uncomplicated Elective Colectomy and Risk of Postdischarge Complication
Michael Balas1, Fayez Quereshy1,2, Jordan Bohnen3
1From the Temerty Faculty of Medicine (Balas, Quereshy, Jung), University of Toronto, Toronto, ON, Canada.
Journal of the American College of Surgeons
|November 1, 2023
Summary
Early discharge after uncomplicated colectomy is safe for minimally invasive surgery, reducing post-discharge complications. This finding supports clinical judgment in selecting patients for early discharge, optimizing patient outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes Research
- Health Services Research
Background:
- Retrospective cohort study analyzing adult patients undergoing uncomplicated elective colectomy (January 2012-December 2019).
- Colectomy defined as uncomplicated if no in-hospital complications were reported.
- Focus on the association between discharge timing and post-discharge complications.
Purpose of the Study:
- To examine the association between early discharge and post-discharge complications.
- Investigate safety and efficacy of early discharge protocols.
- Evaluate clinical judgment in patient selection for early discharge.
Main Methods:
- Stratified patients into early (laparoscopic/robotic ≤3 days, open ≤5 days) and delayed discharge groups.
- Utilized propensity score matching for comparison.
- Analyzed post-discharge complications using unadjusted logistic regression.
Main Results:
- Early discharge associated with lower post-discharge complication odds in laparoscopic (OR 0.73) and robotic (OR 0.63) colectomy.
- No significant difference in complication odds for open colectomy (OR 1.02).
- No clinically meaningful differences in return to operating room across all approaches.
Conclusions:
- Early discharge is safe and linked to reduced complications in minimally invasive colectomy.
- Findings support the clinical judgment of surgical teams in identifying suitable candidates for early discharge.
- Suggests potential for optimizing hospital resource utilization and patient recovery pathways.
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