Pragmatic Criteria for Early Discharge After Laparoscopic Colorectal Surgery: Safety and Applicability Outside ERAS...

Background/Objectives: Enhanced Recovery After Surgery (ERAS) protocols improved outcomes in colorectal surgery, but global implementation remains heterogeneous. In centers without structured ERAS programs, the lack of standardized discharge criteria could lead to conservative decisions and prolonged hospital stays. This study aimed to evaluate the feasibility and safety of early discharge (ED) on postoperative day (POD) 3 using the five Tavernier's criteria in a real-world setting without formal ERAS pathways. Methods: This retrospective analysis of a prospectively maintained database included all consecutive adult patients undergoing elective laparoscopic colorectal resection between February 2025 and February 2026 at a high-volume tertiary center. Patients were stratified into the EARLY group (discharged on POD 3 upon fulfilling all five Tavernier criteria: C-reactive protein < 150 mg/L, temperature < 38 °C, passage of flatus, Visual Analogue Scale score < 5, and oral diet tolerance) and the STANDARD group (discharged after POD 3). The primary endpoint was the safety and negative predictive value (NPV) of the five-criteria bundle regarding 30-day complications. Results: Seventy-seven patients were included (EARLY: n = 44; STANDARD: n = 33). In the STANDARD group, the primary barriers to discharge were prolonged intravenous analgesic requirements (81.8%) and delayed bowel function (36.4%). The five-criteria bundle demonstrated an NPV of 84.1%, a sensitivity of 68.2%, and a specificity of 67.3% for identifying patients at low risk of complications. The overall 30-day complication rate was significantly lower in the EARLY group compared to the STANDARD group (15.9% vs. 45.5%; p = 0.010). No major complications (Clavien-Dindo ≥ III) occurred in the EARLY group compared to 6.1% in the STANDARD group. Conclusions: This exploratory feasibility analysis suggests that early discharge on POD 3 guided by the five Tavernier criteria is potentially safe and feasible in a real-world clinical setting without formal ERAS pathways. However, given the small sample size and inherent methodological biases, these findings remain preliminary, and larger prospective multi-center trials are strictly required to validate the safety and formal impact of this strategy.