Is Same-Day and Next-Day Discharge After Laparoscopic Colectomy Reasonable in Select Patients?

Background Discharge on postoperative day 3 after laparoscopic colorectal resections is now common, and same-day discharge has been proposed recently as an option. Objective The purpose of this study was to determine the safety of same-day and next-day discharge after laparoscopic colorectal surgery and to delineate which characteristics may make a patient eligible for this pathway. Design This was a retrospective cohort study. Settings The American College of Surgeons National Surgical Quality Improvement Project Targeted Colectomy Participant User File was used. Patients Patients underwent elective laparoscopic colorectal resection and were discharged without complications on or before postoperative day 5 (early discharge: postoperative day 0 or 1, intermediate: postoperative day 2, standard: postoperative day 3 to 5). Main outcome measures Early readmission (on or before postoperative day 7), anastomotic leak, ileus, and overall readmission were measured. Results Of 36,526 patients total, 906 (2.5%) were discharged on postoperative day 0 or 1. Patients discharged on postoperative day 0/1 tended to have shorter-duration operations, a diagnostic indication more commonly of benign neoplasm, and underwent less low pelvic anastomoses. The readmission rate within 7 days was only 2%. Overall rates of anastomotic leak (0.6% early, 1.0% intermediate, 1.2% standard), ileus (1.9% early, 1.5% intermediate, 2.1% standard), and readmission (early 4.8%, intermediate 5.1%, standard 5.8%) were equivalent to decreased in patients discharged early versus those discharged in the intermediate or standard discharge groups. On multivariable analysis, dismissal day remained a noncontributory-to-protective factor against anastomotic leak, ileus, and readmission. Limitations Specific follow-up pathways used were unknown, and selection bias exists in deciding what day patients can be discharged. Conclusions Discharge on the same day or next day after surgery was not associated with increased risk compared with discharge on postoperative day 3 to 5, and it did not result in a high rate of early readmissions. Increased use of expedited discharge pathways would reduce hospital costs and resource use. See Video Abstract at http://links.lww.com/DCR/B331. ?ES RAZONABLE EL ALTA EL MISMO DiA O AL DiA SIGUIENTE, DESPUeS DE LA COLECTOMiA LAPAROSCoPICA EN PACIENTES SELECCIONADOS: Es comun el alta hospitalaria en el 3er dia postoperatorio, despues de resecciones colorrectales laparoscopicas. Recientemente se ha propuesto como una opcion, el alta el mismo dia.Determinar la seguridad de alta el mismo dia o al dia siguiente despues de la cirugia colorrectal laparoscopica, y delinear que caracteristicas pueden hacer que un paciente sea elegible para esta via.Estudio de cohorte retrospectivo.American College of Surgeons National Surgical Quality Improvement Project Targeted Colectomy Participant User File.Se sometieron a reseccion colorrectal laparoscopica electiva, y se dieron de alta sin complicaciones durante el 5° dia postoperatorio o antes (alta temprana: dia 0 o 1 postoperatorio; intermedia: dia 2 postoperatorio; estandar: dia 3-5 postoperatorio).Reingreso temprano (en o antes del dia 7 postoperatorio), fuga anastomotica, ileo y reingreso general.De 36,526 pacientes en total, 906 (2.5%) fueron dados de alta en el dia 0 o 1 postoperatorio. Los pacientes dados de alta en el dia 0/1 postoperatorio, tendieron a presentar operaciones de menor duracion, indicacion diagnostica mas frecuente de neoplasia benigna, y sometidos a menos anastomosis de pelvis baja. La tasa de readmision dentro de los siete dias, fue del 2%. Las tasas generales de fuga anastomotica (0.6% temprana, 1.0% intermedia, 1.2% estandar), ileo (1.9% temprana, 1.5% intermedia, 2.1% estandar) y reingreso (temprana 4.8%, intermedia 5.1%, estandar 5.8%) fueron equivalentes a la disminucion en pacientes dados de alta temprana, versus aquellos dados de alta en los grupos intermedia o estandar. En el analisis multivariable, el dia de alta no contribuyo al factor protector contra la fuga anastomotica, el ileo y el reingreso.Se desconocen las vias de seguimiento especificas utilizadas y existe un sesgo de seleccion al decidir en que dia se puede dar de alta a los pacientes.El alta el mismo dia o al dia siguiente despues de la cirugia, no se asocio con un mayor riesgo, en comparacion con el alta en el postoperatorio en los dias 3-5, y no dio lugar a una alta tasa de reingresos tempranos. Mayor utilizacion de las vias de alta acelerada, reducirian costos hospitalarios y utilizacion de recursos. Consulte Video Resumen en http://links.lww.com/DCR/B331. (Traduccion-Dr Fidel Ruiz Healy).