Ileostomy closure at an ambulatory surgery center: an initial assessment of feasibility and safety

Same-day discharge (SDD) following bowel surgery is associated with reduced healthcare resource utilization. Performing these surgeries at ambulatory surgery centers (ASCs) might further optimize efficiency. Ileostomy closure may be the ideal procedure for SDD at an ASC. We sought to investigate the feasibility and safety of ileostomy closures performed at an ASC.

A retrospective review of adult patients undergoing elective ileostomy reversal planned with SDD at a single university-affiliated colorectal referral center (02/2020-07/2024) was conducted. Patients were stratified by site of operation: hospital or ASC. The primary outcomes were as follows: (1) safety, measured by 30-day complication rate, and (2) feasibility, defined as successful postoperative day (POD) 0 discharge without an emergency department (ED) visit or readmission within 72 h. Secondary outcomes included 30-day ED visits, readmissions, and length of stay on readmission. Fisher's exact and Wilcoxon Rank-Sum tests were used for categorical and continuous variables, respectively.

Seventy-six patients met inclusion criteria (64 hospital, 12 ASC). The ASC cohort had a higher proportion of male patients; otherwise, baseline characteristics were comparable. Feasibility did not differ significantly between groups (ASC 67%vs. hospital 84%, p = 0.217); however, ED visits within 72 h were more frequent in the ASC group (33% vs. 8%, p = 0.030). There were no differences in the incidence of 30-day complications (ASC 41.7% vs. hospital 23.4%, p = 0.282) or ED visits (ASC 41.7% vs. hospital 19.0%, p = 0.161). The incidence of 30-day readmissions was higher in the ASC group (42% vs.13%, p = 0.027), but with no difference in median length of stay (3.5 [2.5-16.5] vs.3 [1-4], p = 0.484).

Our initial experience with SDD ileostomy closure performed at an ASC demonstrated inferior outcomes compared to a hospital setting. The ASC cohort was more likely to require early readmission, likely due to the logistical limitations. Stricter patient selection criteria may be necessary to optimize outcomes in the ASC setting.