Early Discharge after Uncomplicated Elective Colectomy and Risk of Post-Discharge Complication.

BACKGROUND

This was a retrospective cohort study of adult patients undergoing uncomplicated elective colectomy using the National Surgical Quality Improvement Program database from January 2012 to December 2019. A colectomy is deemed uncomplicated if there was no complication reported during the hospitalization. The objective of this study was to examine the association between discharge timing and post-discharge complications in patients who undergo uncomplicated elective colectomy.

METHODS

Patients were stratified into an early discharge group if their length of postoperative hospitalization was ≤3days for laparoscopic or robotic approaches, or ≤5days for the open approach, and otherwise into delayed discharge groups. The association between early discharge and any post-discharge complication was examined using unadjusted logistic regression after propensity score matching between early and delayed discharge groups.

RESULTS

Of the 113,940 patients included, 77,979, 15,877, and 20,084 patients underwent uncomplicated laparoscopic, robotic, and open colectomy, respectively. After propensity score matching, the odds of a post-discharge complication were lower for the early discharge group in laparoscopic (OR 0.73, 95%-CI 0.68-0.79) and robotic (OR 0.63, 95%-CI 0.52-0.76) approaches, and not different in the open approach (OR 1.02, 95%-CI 0.91-1.15). There were no clinically meaningful differences in the risk of return to the operating room for all surgical approaches.

CONCLUSIONS

Early discharge after uncomplicated colectomy appears to be safe and is associated with lower odds of post-discharge complications in minimally invasive approaches. Our findings suggest that surgical teams practice sound clinical judgments on selecting patients who benefit from early discharge.

Informations de copyright

Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.