North American multicentre evaluation of a same-day discharge protocol for minimally invasive colorectal surgery using mHealth or telephone remote post-discharge monitoring

Lee, Lawrence; Eustache, Jules; Tran-McCaslin, Marie; Basam, Motahar; Baldini, Gabriele; Rudikoff, Andrew G.; Liberman, Sender; Feldman, Liane S.; McLemore, Elisabeth C.

doi:10.1007/s00464-022-09208-8

Cited by 17 publications

(41 citation statements)

References 20 publications

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“…Since the initial patient in February 2020, Lee and colleagues have recruited over 100 patients for SDD [ 44 ]. Overall, SDD accounts for 25% of their major elective colorectal resections, and approximately 50% of the patients undergoing eligible procedures are recruited to SDD.…”

Section: Preliminary Results With Sdd Crs: the Us And Canadian Experi...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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Section: Preliminary Results With Sdd Crs: the Us And Canadian Experi...mentioning

confidence: 99%

Same day discharge following elective, minimally invasive, colorectal surgery

et al. 2022

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“…For context only, the previously published safety and feasibility outcomes of the pilot SDD ERP are summarized as follows. 7 Thirty-three (89%) patients had zero complications, emergency department or urgent care visits, re-operations, or hospital readmissions during the first 7 days. This continued to hold true for 30 (81%) patients during the remaining 30-day post-operative recovery period.…”

Section: Resultsmentioning

confidence: 99%

“…In our experience, SDD is a safe and feasible alternative to hospitalization for elective, minimally invasive, major abdominal colorectal procedures in well-selected patients. 7 In this small pilot SDD program, patients utilized fewer narcotics at home than initially hypothesized. This led to a clinical change in practice, reducing the total tablet quantity to #10 oxycodone 5 mg.…”

Section: Discussionmentioning

confidence: 96%

“…The safety and feasibility of the SDD pilot program has already been published. 7 The patient demographics and operative outcomes are summarized in the results section for context purposes only, as the scope of this manuscript is focusing on opioid use and prescribing in the SDD pilot program. 7 …”

Section: Methodsmentioning

confidence: 99%

“… 6 Collaborating with our colleagues at McGill University, we have recently published a combined postoperative outcomes following SDD, further demonstrating the safety and feasibility of SDD. 7 Intrigue and interest in SDD is evolving into implementation, as the surgical community is transitioning from the pioneer to early adopter phase of SDD. However, there is limited information regarding the impact of SDD ERPs on post-operative pain and opioid use in patients recovering at home.…”

Section: Introductionmentioning

confidence: 99%

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Reduced Opioid Use and Prescribing in a Same Day Discharge Pilot Enhanced Recovery Program for Elective Minimally Invasive Colorectal Surgical Procedures During the COVID-19 Pandemic

Tran-McCaslin

Basam

Rudikoff

et al. 2022

The American Surgeon

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Purpose Enhanced recovery pathways (ERPs) are associated with reduced complications and length of stay. The validation of the I-FEED scoring system, advances in perioperative anesthesia, multimodal analgesia, and telehealth remote monitoring have resulted in further evolution of ERPs setting the stage for same day discharge (SDD). Pioneers and early adopters have demonstrated the safety and feasibility of SDD programs. The aim of this study is to evaluate the impact of a pilot SDD ERP on patient self-reported pain scoring and narcotic usage. Methods A quality improvement pilot program was conducted to assess the impact of a SDD ERP on post-operative pain score reporting and opioid use in healthy patients undergoing elective colorectal surgery as an alternative to post-operative hospitalization during the COVID-19 pandemic (May 2020-December 2021). Patients were monitored remotely with daily telephone visits on POD 1-7 assessing the following variables: I-FEED score, pain score, pain management, bowel function, dietary advancement, any complications, and/or re-admissions. Results Thirty-seven patients met the highly selective eligibility criteria for “healthy patient, healthy anastomosis.” SDD occurred in 70%. The remaining 30% were discharged on POD 1. Mean total narcotic usage was 5.2 tablets of 5 mg oxycodone despite relatively high reported pain scores. Conclusions In our initial experience, SDD is associated with significantly lower patient narcotic utilization for postoperative pain management than hypothesized. This pilot SDD program resulted in a change in clinical practice with reduction of prescribed discharge oxycodone 5 mg quantity from #40 to #10 tablets.

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