Universal same-day discharge after colonic resection: a matched cohort study

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Patient Discharge Protocols

Background:

• Enhanced Recovery Protocols (ERPs) have significantly improved outcomes in colorectal surgery.
• Same-day discharge (SDD) is a promising advancement but typically limited to highly selected patients.
• The expansion of SDD to a broader patient population requires careful evaluation.

Purpose of the Study:

• To evaluate the safety and efficacy of a universal same-day discharge (USDD) program.
• To compare USDD against traditional ERPs in a wider patient cohort.
• To assess non-inferiority of USDD regarding 30-day complications, readmissions, and reoperations.

Main Methods:

• Retrospective matched cohort study at a single U.S. institution.
• Comparison of 36 patients in a USDD program versus a matched control group on traditional ERP.
• USDD eligibility: outpatient agreement, minimally invasive surgery, no new stoma, caregiver support.

Main Results:

• USDD group exhibited shorter operative times, increased transversus abdominis plane (TAP) block use, and reduced intraoperative fluid administration.
• No significant differences in 30-day post-operative complications or reoperations between USDD and ERP groups.
• Higher rates of emergency department visits and readmissions were observed in the USDD group.

Conclusions:

• Universal same-day discharge (USDD) appears safe and non-inferior to traditional ERP for selected colorectal surgery patients.
• SDD may be safely expanded to a broader patient population.
• Further prospective studies are warranted to validate these findings and optimize USDD protocols.