Same-Day Discharge After Minimally Invasive Colectomy

Lee, Lawrence; McLemore, Elisabeth C.; Rashidi, Laila

doi:10.1001/jamasurg.2022.4123

Cited by 11 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several operative variations can further improve patient recovery by minimising operative trauma and pain, including intracorporeal versus extracorporeal anastomosis for laparoscopic right hemicolectomy [ 43 ]. Pfannenstiel specimen extraction versus midline specimen extraction [ 44 ], or natural orifice specimen extraction versus conventional transabdominal specimen extraction [ 45 , 46 ]. Individual surgeon expertise and experience are important factors [ 47 , 48 ], as well as proficiency with the surgical platforms used, including conventional laparoscopy, robotic surgery, or transanal approaches.…”

Section: Discussionmentioning

confidence: 99%

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Zheng

Wee

Abdullah

et al. 2023

Int J Colorectal Dis

View full text Add to dashboard Cite

Background Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or “hyper-ERAS”, is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery. Methods The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool. Results Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort. Conclusion SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Zheng

Wee

Abdullah

et al. 2023

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…1 Same-day discharge (SDD) pathways represent the evolution of ERPs by optimizing the elements of perioperative care that keep patients hospitalized after colorectal surgery. 2,3 After an initial series from France, studies from Canada and the United States have demonstrated its feasibility in different settings and with different modalities of postdischarge care. [4][5][6] The implementation of SDD protocols after colectomy requires a multifaceted approach, including advanced surgical techniques, opioid-sparing analgesia to promote return of bowel function, early remote follow-up methods, and patient-related factors.…”

Section: Limitaciones: Estudio Unicéntricomentioning

confidence: 99%

“…3 Many of the barriers to SDD implementation focus on the potential for SDD failure and/or early readmission, which may result in negative clinical and economic outcomes. 2 Identification of factors predictive of SDD success or failure may provide early "warning signs" for providers to keep patients hospitalized instead of discharged on the day of surgery, thus decreasing several of the barriers to SDD implementation by increasing the chances of success. Therefore, the primary objective of this study was to identify patient-related or perioperative factors that impact SDD success and failure.…”

Section: Limitaciones: Estudio Unicéntricomentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Paradis,

Robitaille,

Wang

et al. 2023

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Along with a few other researchers, our group has previously published the results of our same day discharge (SDD) after minimally invasive colectomies. [4][5][6][7] Yet there is scant examination of postoperative opioid requirements in this specific population and how they affect outcomes such as readmissions. Older work in the past has identified early discharge as a significant risk factor for readmission.…”

mentioning

confidence: 99%

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Vu,

Franko,

Buzadzhi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

Self Cite

View full text Add to dashboard Cite

Background: The ongoing opioid crisis demands an investigation into the factors driving postoperative opioid use. Ambulatory robotic colectomies are an emerging concept in colorectal surgery, but concerns persist surrounding adequate pain control for these patients who are discharged very early. We sought to identify key factors affecting recovery room opioid use (ROU) and additional outpatient opioid prescriptions (AOP) after ambulatory robotic colectomies. Methods: This was a single-institution retrospective review of ambulatory robotic colon resections performed between 2019 and 2022. Patients were included if they discharged on the same day (SDD) or postoperative day 1 (POD1). Outcomes of interest included ROU [measured in parenteral morphine milligram equivalents (MMEs)], AOP (written between PODs 2 to 7), postoperative emergency department presentations, and readmissions. Results: Two hundred nineteen cases were examined, 48 of which underwent SDD. The mean ROU was 29.4 MME, and 8.7% of patients required AOP. Between SDD and POD1 patients, there were no differences in postoperative emergency department presentations, readmissions, recovery opioid use, or additional outpatient opioid scripts. Older age was associated with a lower ROU (−0.54 MME for each additional year). Older age, a higher body mass index, and right-sided colectomies were also more likely to use zero ROU. Readmissions were strongly associated with lower ROU. Among SDD patients, lower ROU was also associated with higher rates of AOP. Conclusion: Ambulatory robotic colectomies and SDD can be performed with low opioid use and readmission rates. Notably, we found an association between low ROU and more readmission, and, in some cases, higher AOP. This suggests that adequate pain control during the postoperative recovery phase is a crucial component of reducing these negative outcomes.

show abstract

Same-Day Discharge After Minimally Invasive Colectomy

Abstract: This article describes elements of a same-day discharge program for minimally invasive colectomy as an evolution of enhanced recovery pathways for colorectal surgery.

Cited by 11 publications

References 8 publications

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review

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

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Contact Info

Product

Resources

About