Enhanced Recovery 2.0 – Same Day Discharge With Mobile App Follow-up After Minimally Invasive Colorectal Surgery

Abstract

Objective: To investigate the feasibility of SDD protocol with postdischarge follow-up using a mobile phone app in patients undergoing elective minimally-invasive colectomy. Summary of Background Data: Discharge before gastrointestinal recovery and use of mobile health technology for remote follow-up may allow for SDD after minimally-invasive colectomy within an ERP. Methods: Adult patients undergoing elective laparoscopic colectomy or loop ileostomy reversal from February 2020 to November 2020 were screened for eligibility. Patients were eligible if they lived within a 30-minute drive from the hospital, had an adequate support system at home, and owned a smart phone. Patients were discharged from the recovery room on the day of surgery based on set criteria with postdischarge remote follow-up using a mobile application. Feasibility was defined as discharge on the day of surgery without emergency department (ED) visit or readmission within the first 3 days. 30-day complications, ED visits, and readmissions were compared to a non-SDD historical cohort (May 2019-March 2020) also remotely followed-up using the same mobile phone app (standard ERP group). Results: A total of 48 patients were recruited to SDD, of which 77% were discharged on the day of surgery without subsequent ED visit in the first 72 hours. There were 11 patients that could not be discharged, including 7 for failure of discharge criteria and 4 for intraoperative complications/ concerns. Overall 30-day complications in the SDD group (17%) was similar to the standard ERP group (15%, P = 0.813). ED visits (SDD10% vs standard ERP8%, P = 0.664) and readmissions (6% vs 4%, P = 0.681) were also similar. Conclusions and Relevance: Findings from this study support the feasibility of a SDD protocol in select patients undergoing minimally-invasive colorectal resection. SDD colectomy protocols may represent the next evolution of ERP and postoperative recovery.

Same day discharge following elective, minimally invasive, colorectal surgery

“…Next, a SDD protocol for laparoscopic colectomy and stoma reversal with remote post-discharge follow-up with a mHealth phone app was implemented in February 2020 [43]. Strict inclusion/exclusion criteria were used (Table 4).…”

“…In this study, patients were discharged on the day of surgery directly from the post-anesthesia care unit (PACU) if they tolerated clear liquids, had adequate oral analgesia, and were able to ambulate and urinate independently. Preliminary results with 48 patients undergoing laparoscopic colectomy and planned for SDD reported that 77% of patients were successfully discharged on the same day as surgery [43]. None of the patients required an ED visit within the first 72 h after discharge.…”

Feasibility and Safety of Ambulatory Surgery as the Next Management Paradigm in Colorectal Resection Surgery

“…14 A study of 37 patients discharged on the day of surgery following laparoscopic colectomy or loop ileostomy reversal reported a 17% complication rate and 6% readmission rate, compared to 15% and 4%, in their standard ERAS group, respectively. 15 In terms of the timing of discharge, our study differs in some characteristics from the previous reports relating to ambulatory surgery from the Centers in France and the UK. The study from the UK 11 admitted all patients overnight and discharged them home the next AM.…”

“…They reported their shortest LOS as 7 hours, but did not specify how many patients were discharged that early. Lee et al15 did not report hourly LOS times in their study of same-day discharge.…”

“…There were equivalent rates of anastomotic leak, ileus and readmission between all discharge groups 14. A study of 37 patients discharged on the day of surgery following laparoscopic colectomy or loop ileostomy reversal reported a 17% complication rate and 6% readmission rate, compared to 15% and 4%, in their standard ERAS group, respectively 15…”