Having Outpatient Major Elective (HOME) Robotic Colon Resection Protocol: A Safe Approach to Ambulatory Colon Resection

Abstract

Background Within the past decade, colorectal surgery length of stay (LOS) has decreased from an average of 5-6 days to 2-3 days. However, elective colon resections have yet to become a common procedure with the potential for same-day discharge. During the COVID pandemic, hospital capacity was exceptionally strained and colon resections were delayed due to the lack of inpatient beds available. Purpose We sought to create a protocolized ERAS (enhanced recovery after surgery) pathway that would allow for safe and feasible ambulatory colon resections as well as decreasing overall hospital inpatient burden. Research Design Between November 2020 and March 2022, 15 patients were offered same-day discharges under the HOME protocol. Of the 15 patients, 11 patients agreed to be discharged home the day of surgery and followed prospectively for 30 days. All procedures were performed robotically. Study Sample Patients were selected based on level of preoperative health (ASA class 1 and 2), low-risk for loss to follow-up, ability for close family supervision for 3 days postoperatively, and type of procedure (partial colectomy). Close follow-up was achieved with daily telephonic or televideo visits for 3 days post-operatively, as well as a 2-week outpatient clinic follow-up. Data Collection A total of 11 patient underwent same-day surgery utilizing the protocol, 5 females and 6 males, between the ages of 34 and 62. All patients were ASA class 2. Indications for colon resection were cecal volvulus (1), recurrent sigmmoid diverticulitis (9), and Crohn's disease (1). Primary outcome was readmission rates within the 30-days. Results There were no readmissions or complications during the perioperative 30-day period. There was one emergency department return for pain who was not admitted. Average operative time was 132.1 minutes. Conclusion Using a novel enhanced recovery protocol, we demonstrated the feasibility and safety of ambulatory partial colectomy in a highly select small subset of patients.

Robotic ambulatory colorectal resections: a systematic review

“…A total of 4 articles were published from 2021 to 2023. These include 2 retrospective [ 25 , 26 ] and 2 prospective [ 27 , 28 ] articles. The number of patients ranged from 3 [ 28 ] to 115 [ 26 ], with a total of 136 patients.…”

“…The number of patients ranged from 3 [ 28 ] to 115 [ 26 ], with a total of 136 patients. 3 of the studies [ 25 – 27 ] were carried out in United States of America (USA), while only 1 [ 28 ] was conducted in the United Kingdom (UK) (Table 2 ).…”

“…3 of the studies [ 25 – 27 ] were carried out in United States of America (USA), while only 1 [ 28 ] was conducted in the United Kingdom (UK) (Table 2 ).…”

“…The mean age was 58 ( range 21–89 years). BMI was only reported in 2 studies [ 27 , 28 ] and had a mean of 25 and 29 kg/m 2 , with a cumulative range of 21–39 kg/m 2 . The ASA scores were reported in 3 studies, where 2 of the studies [ 27 , 28 ] reported that all patients had an ASA II grade, while Curfman et al [ 26 ] limited the patient population to a maximum of ASA III.…”

“…BMI was only reported in 2 studies [ 27 , 28 ] and had a mean of 25 and 29 kg/m 2 , with a cumulative range of 21–39 kg/m 2 . The ASA scores were reported in 3 studies, where 2 of the studies [ 27 , 28 ] reported that all patients had an ASA II grade, while Curfman et al [ 26 ] limited the patient population to a maximum of ASA III. The types of surgery carried out were as follows (136 patients): 48% in low anterior resections, 21% in right colectomies, 11% in sigmoidectomies, 7% in cecectomies, 2% in transverse colectomies, proctectomies, left colectomies and high anterior resections each, and 1% in Hartmann’s reversal procedure.…”