Evaluating Outcomes of Same Day Discharge After Minimally Invasive Colectomy: A Nationwide Analysis.

Abstract

Background: Advances in Enhanced Recovery After Colectomy protocols have enabled same day discharge (SDD) in some patients. Current literature is limited to single institutions limiting generalizability. We employed a nationally-representative dataset to compare outcomes between SDD patients and patients with a short-term hospital stay (discharged on postoperative day 1 or 2).

Methods: We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) Targeted Colectomy Participant User Files (2017-2021). We included patients ≥18 years who underwent elective minimally invasive colectomy. We excluded patients with severe comorbid conditions or in-hospital complications. We performed a 1:1 propensity-match adjusting for patient, diagnosis, and procedure- type characteristics. Our primary outcome was 30-day readmission and secondary outcome was post-discharge complications.

Results: We identified 22,482 patients, 740 (3.3%) of which were SDD patients. A higher proportion of patients with SDD underwent right colectomy (76.4% vs36.4%, P < 0.001) and carried a diagnosis of a benign neoplasm (53.0% vs18.1%, P < 0.001). After propensity matching there was no significant difference in the rate of 30-day readmission between the 2 groups (3.4% vs4.7%; P = 0.23). Additionally, there was no significant difference in rates of anastomotic leak (0.7% vs0.8%; P = 0.58) or colonic ileus (1.4% vs1.8%; P = 0.58). Post-discharge bleeding complications were higher in SDD patients (0.5% vs0%; P = 0.045).

Conclusions: SDD following minimally invasive colectomy is not associated with higher readmission, anastomotic leak, or SSI when compared to patients discharged on postoperative day 1/2. SDD after minimally invasive colectomy may be considered for patients without severe comorbid conditions.