Predictive Factors for Successful Same-Day Discharge Following Minimally Invasive Colectomy and Stoma Reversal

Abstract

BACKGROUND: Same-day discharge following minimally invasive colorectal surgery is a safe, effective practice in specific patients that can enhance the efficiency of enhanced recovery pathways. OBJECTIVE: To identify predictive factors associated with success or failure of same day discharge. DESIGN: Prospective cohort study from January 2020 to March 2023. SETTINGS: Tertiary colorectal center. PATIENTS: Adult patients eligible for same day discharge with remote postdischarge follow-up included those with minimal comorbidities, residing neat the hospital, having sufficient home support, and owning a mobile device. INTERVENTIONS: Patients were discharged on the day of surgery upon meeting specific criteria, including adequate pain control, tolerance of oral intake, independent mobility, urination, and the absence of complications. Successful same-day discharge was defined as discharge on the day of surgery without unplanned visits in the first 72 hours. MAIN OUTCOME MEASURES: Factors associated with successful or failed same day discharge after minimally invasive colorectal surgery. RESULTS: A total of 175 (85.3%) patients were discharged on the day of surgery with 14 (8%) patients having an unplanned visit within 72 hours. Overall 161 (78.5%) patients were categorized as same-day discharge success and 44 (21.5%) patients as same-day discharge failure. The same-day discharge failure group had a higher Charlson Comorbidity Index (3.7, 2.8, p = 0.03). Mean length of stay (0.8, 3.0, p = 0.00), 30-day complications (10%, 48%, p = 0.00) and readmissions (8%, 27%, p = 0.00) were higher in the same-day discharge failure group. Regression analysis showed that failed same-day discharge was associated with higher comorbidities (OR 0.79, 95% CI 0.66, 0.95) and prolonged postanesthesia-care-unit time (OR 0.99, 95% CI 0.99, 0.99). Individuals who received a regional-nerve-block (OR 4.1, 95% CI 1.2, 14) and those who did not consume postoperative opioids (OR 4.6, 95% CI 1-21) were more likely to have successful same-day discharge. LIMITATIONS: Single center study. CONCLUSIONS: Our findings indicate that comorbidities and prolonged post-anesthesia care unit stays were associated with same day discharge failure, while regional nerve blocks and minimal postoperative opioids were related to success. These factors may inform future research aiming to enhance colorectal surgery recovery protocols. See Video Abstract.