Safety of hospital discharge before return of bowel function after elective colorectal surgery

Abstract

Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.

A retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway

“…However, when evaluating our early discharge group, results show no significant difference in outcomes between those who had full return of gastrointestinal function and those who did not. In a recent large multicenter prospective study, discharge prior to return of bowel function was found to be safe in selected patients undergoing elective colorectal surgery [ 3 ]. These results suggest that discharge prior to recovery of gastrointestinal function is safe.…”

“…However, most ERPs heavily rely on the return of gastrointestinal function as a necessary criteria for discharge [ 2 ]. Furthermore, there is emerging evidence that discharge prior to full gastrointestinal recovery within an ERP may be safe in selected patients and has not been associated with increased morbidity [ 3 ]. Considering these findings, recent studies have been successful in implementing same day discharge (SDD) protocols for minimally invasive colectomy in highly selected patients [ 4 , 5 ].…”

“…Despite the potential benefits of advanced ERPs and SDD protocols, strict inclusion criteria may limit their generalizability and applicability to a wider patient population [ 3 – 5 ]. As a result, there may be a significant number of patients who are excluded but would otherwise be reasonable candidates for early discharge within an established ERP or a SDD protocol.…”

Promoting Laparoscopic Anterior Approach for a Very Low Presacral Primary Neuroendocrine Tumor Arising in a Tailgut Cyst

“…In the present study, complete laparoscopic excision with an anterior approach was performed as the treatment of choice, guaranteeing preservation of the pelvic plexus without entering the cysts and avoiding rectal injury. For upper abdominal tumors [21][22][23], minimally invasive surgery for retrorectal tumors allows safe resection of the tumor, reducing bleeding and injury [24], and improving recovery [25].…”

Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2)

“…Postoperative ileus: absence of passage of gas or stools, and inability to tolerate oral intake or need for a nasogastric tube placement for more than 5 days. Recovery of bowel function will be assessed using the GI-2 method [15][16][17][18]: the sum of the first day of stool passage and the day on which a soft diet is started. A normal recovery is defined by achieving GI-2 within 10 days from surgery.…”