Temporal trends in outpatient right colectomy: a contemporary multistate study

Outpatient colectomy has been shown to be safe and effective in small, single or multicenter institutional series. Early discharge following colorectal surgery has been made possible, in part, by standardization of perioperative care and postoperative monitoring. We examined modern national trends in the use of outpatient right colectomy (ORC) to inform future practice patterns.

We performed a retrospective cohort study of adult patients undergoing elective ORC using the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery and Services Databases from 2016 to 2021. Data were linked to the American Hospital Association survey to calculate cost in 2021 US dollars. Outpatient surgery was defined as a length of stay ≤ 1 day. The primary outcomes were the annual frequency of ORC and annual proportion of ORC per total colectomies. The Cochran-Armitage test of trend was used to compare annual frequency and proportion of ORC. Regression models were used to assess total admission cost and 30-day readmission by year. Spearman's correlation assessed annual trends.

Of 49,416 right colectomies meeting the study criteria, 1933 (3.9%) underwent ORC. The ORC median [IQI] patient age was 63 [54, 70] years and 85.8% underwent a minimally invasive approach. There was a significant increase in the annual frequency (p = 0.03) and proportion (p < 0.001) of ORC over time. There were no significant differences in 30-day readmission rates over time (p = 0.44). A significant increase in risk-adjusted yearly total cost for ORC was identified, ranging from $9,447 in 2016 to $14,544 in 2021 (Spearman's correlation test rho = 1, p = 0.003).

In a contemporary geographically representative cohort, the practice of ORC increased over five years without differences in readmission rates. ORC cost increases potentially indicate an increased resource requirement to provide acute postoperative care in the ambulatory setting.