Road Towards Ambulatory Colectomy: Patient Outcomes and Experience During a Feasibility Study

This prospective, monocentric study aims to standardize and implement an One-Night Stay (ONS) colectomy pathway.

Enhanced Recovery Pathways (ERP) for colorectal surgery have become standard of care. Same-Day Discharge (SDD) and ONS protocols demonstrated to be feasible. These protocols challenge traditional care models and necessitate robust remote monitoring. However, concerns remain about scalability and delayed complications diagnosis.

A multimodal remote monitoring system was implemented, including an Interactive home monitoring application, remote wearable monitoring, and a centralized dashboard. Postoperative care involved real-time vital sign tracking, twice-daily questionnaires, and blood tests on postoperative days (POD) 1, 3, and 5. A 1:1 pair-matched control group compared ONS with traditional ERP.

Between 2023 and 2025, 370 patients underwent minimally invasive non-IBD segmental colectomy, 59 were eligible and 26 agreed to participate. Mean age was 53.7±13.1 years, 54% were female and mean BMI was 25 kg/m². Median CRP decreased from 33.1 (POD1) to 13.0 (POD5). Patient satisfaction was high (8.5/10), and physical activity levels improved rapidly from 2/10 (POD1) to 7/10 (POD10). A matched cohort of 23 ERP patients was identified for comparison. ONS patients had lower pain scores POD1 [VAS -3.0 95% CI (-3.9, -2.2)] and significantly shorter median length of stay (LOS) (1 vs. 4 days).

This pilot study demonstrates that ONS, with preoperative education, real-time remote vital sign tracking, and telehealth support, significantly reduces LOS without increasing complication or readmission rates. ONS patients showed high satisfaction, fast recovery of physical activity, and comparable postoperative outcomes to traditional ERP.