Day 1 Discharge for All Patients After Minimally Invasive Colon Surgery: A Prospective Cohort Study

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Patient Recovery

Background:

• Minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols facilitate early discharge (1-3 days) after colon surgery.
• Routine implementation of 24-72 hour discharge remains variable and often limited to specialized pathways.

Purpose of the Study:

• To evaluate the feasibility and safety of a clinically guided Day-1 discharge pathway for all eligible patients undergoing minimally invasive colon surgery.

Main Methods:

• Prospective cohort study conducted at a tertiary colorectal center from March 2020 to December 2024.
• Included adult patients undergoing minimally invasive colon resection without stoma formation.
• Implemented a pathway where Day 1 discharge was the default target for eligible patients meeting predefined clinical criteria and patient willingness.

Main Results:

• Median length of stay decreased from 3.0 to 1.0 days (p < 0.001).
• Day 1 discharge rates increased from 4.6% to 65.0% (p < 0.001) without significant changes in 30-day readmissions or severe complications.
• No preventable failure to rescue was identified, and discharge rates were sustained over time.

Conclusions:

• Standardized Day 1 discharge is feasible and safe for patients undergoing elective minimally invasive colon surgery without stoma formation.
• The non-randomized design limits causal inference and generalizability.
• Low event rates reduced power for subgroup analyses.