Feasibility assessment of outpatient colorectal resections at a tertiary referral center

Studniarek, Adam; Borsuk, Daniel J.; Kochar, Kunal; Park, John J.; Marecik, Sławomir

doi:10.1007/s00384-020-03782-w

Cited by 14 publications

(46 citation statements)

References 23 publications

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“…After full-text reading of 16 eligible articles, a further five were excluded owing to inclusion of patients undergoing robotic-assisted procedures, inability to retrieve patient data or inclusion of data from patients present in more than one study. Eleven studies met the inclusion criteria and were finally selected for the systematic review [5,6,[12][13][14][15][16][17][18][19][20].…”

Section: Systematic Searchmentioning

confidence: 99%

Ambulatory laparoscopic colectomies: a systematic review

et al. 2023

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Aim Ambulatory laparoscopic colectomy (ALC), meaning discharge within 24 h of surgical colonic resection, has recently been proposed in a few, selected patients. This systematic review was performed with the aim of reviewing protocols for ALC and assessing feasibility, safety and outcomes after ALC. Method A PRISMA‐compliant systematic review and pooled analysis was performed searching all English studies published until October 2022 in PubMed, Cochrane Library, Web of Science (PROSPERO, CRD42022334463). Inclusion criteria were original articles including patients undergoing ALC, specifying at least one outcome of interest. Exclusion criteria were articles reporting a robotic‐assisted procedure; unable to retrieve patient data from articles; the same patient series included in different studies. Primary outcomes were success, overall complications and readmission rates. Secondary outcomes included mortality and specific complications such us surgical site infection, anastomotic leak, ileus, bleeding, rate of ALC acceptance, and unscheduled consultation and reoperation rate. Results Among 1087 studies imported for screening, 11 were included (1296 patients). The success rate was 47% with an overall morbidity of 14%. Readmission and reoperation rates were 5% and 1%, respectively. No mortality was recorded. Protocols of ALC differ significantly among published studies. Conclusions Overall, ALC appears to be safe and feasible in selected cases with an acceptable success rate and a low risk of readmission after hospital discharge. Future studies should evaluate patients' benefits and discharge criteria, as well as uniformity and standardization of eligibility criteria. This systematic review may help inform on ALC adoption in clinical practice.

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Section: Systematic Searchmentioning

confidence: 99%

Ambulatory laparoscopic colectomies: a systematic review

et al. 2023

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“…Analysis of the ACS-NSQIP database reported that only 1.6% of 1905 cases of elective colectomy from 2012 to 2017 and 2.7% of the 24,393 cases of elective stoma closure from 2005 to 2016 were discharged within one day of surgery [16,17]. Results from single-center series suggest that discharge within 24 h occurred in 22-35% of patients undergoing laparoscopic colorectal resection that were managed with an enhanced recovery pathway [18][19][20]. Readmission rates in these patients ranged from 4 to 9%.…”

Section: Preliminary Experience With Pod0-pod1 Colectomy and Ileostom...mentioning

confidence: 99%

Same day discharge following elective, minimally invasive, colorectal surgery

et al. 2022

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Background As enhanced recovery programs (ERPs) have continued to evolve, the length of hospitalization (LOS) following elective minimally invasive colorectal surgery has continued to decline. Further refinements in multimodal perioperative pain management strategies have resulted in reduced opioid consumption. The interest in ambulatory colectomy has dramatically accelerated during the COVID-19 pandemic. Severe restrictions in hospital capacity and fear of COVID transmission forced surgical teams to rethink strategies to further reduce length of inpatient stay. Methods Members of the SAGES Colorectal Surgery Committee began reviewing the emergence of SDD protocols and early publications for SDD in 2019. The authors met at regular intervals during 2020–2022 period reviewing SDD protocols, safe patient selection criteria, surrogates for postoperative monitoring, and early outcomes. Results Early experience with SDD protocols for elective, minimally invasive colorectal surgery suggests that SDD is feasible and safe in well-selected patients and procedures. SDD protocols are associated with reduced opioid use and prescribing. Patient perception and experience with SDD is favourable. For early adopters, SDD has been the natural evolution of well-developed ERPs. Like all ERPs, SDD begins in the office setting, identifying the correct patient and procedure, aligning goals and objectives, and the perioperative education of the patient and their supporting significant others. A thorough discussion with the patient regarding expected activity levels, oral intake, and pain control post operatively lays the foundation for a successful application of SDD programs. These observations may not apply to all patient populations, institutions, practice types, or within the scope of an existing ERP. However, if the underlying principles of SDD can be incorporated into an existing institutional ERP, it may further reduce the incidence of post operative ileus, prolonged LOS, and improve the effectiveness of oral analgesia for postoperative pain management and reduced opioid use and prescribing. Conclusions The SAGES Colorectal Surgery Committee has performed a comprehensive review of the early experience with SDD. This manuscript summarizes SDD early results and considerations for safe and stepwise implementation of SDD with a specific focus on ERP evolution, patient selection, remote monitoring, and other relevant considerations based on hospital settings and surgical practices.

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“…It is now a necessity to highlight, thanks to multicentric studies with robust methodologies, which patients are eligible for laparoscopic colectomy with a discharge less than 24 h after the surgery. A strict appropriate selection of patients with the implementation of ERAS protocols is fundamental [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of a Discharge within 23 Hours after Colorectal Laparoscopic Surgery

Popeskou

Christou

Panteleimonitis

et al. 2022

JCM

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Background: Enhanced or accelerating recovery programs have significantly reduced hospital length stay after elective colorectal interventions. Our work aims at reporting an initial experience with ambulatory laparoscopic colectomy (ALC) to assess the criteria of discharge and outcomes. Methods: Between 2006 and 2016, data regarding patients having benefited from elective laparoscopic colorectal resections in two main centres in the United Kingdom have been analysed. Both benign and malignant pathologies were included. A standardised enhanced recovery program was performed for each patient, except epidural analgesia was replaced with single shot spinal infiltration. Patients were followed up through a telephone call system by a nurse. Short-term clinical outcomes were analysed. Results: A total of 833 patients were included and 51 (6.1%) were discharged within 24 h following surgery. Of these, 4 out of 51 (7.8%) patients came back hospital within 30 days of discharge; 2 (3.9%) required reoperation (Small bowel obstruction and wound abscess drainage). Conclusions: This study highlights that a 24-h discharge following elective laparoscopic colorectal interventions seems safe and feasible in selected patients. Although challenging to achieve, a standardised approach to laparoscopic surgery in combination with strict adherence to an enhanced recovery protocol are the fundamental elements of this path.

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Feasibility assessment of outpatient colorectal resections at a tertiary referral center

Cited by 14 publications

References 23 publications

Ambulatory laparoscopic colectomies: a systematic review

Ambulatory laparoscopic colectomies: a systematic review

Same day discharge following elective, minimally invasive, colorectal surgery

Safety and Feasibility of a Discharge within 23 Hours after Colorectal Laparoscopic Surgery

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