Abstract
Background
Enhanced recovery pathways have become standard practice after elective colorectal surgery to improve postoperative care while reducing length of stay in hospital. However, there is concern that early discharge may result in increased rates of adverse events including readmission. This study aims to determine whether it is safe to discharge patients on postoperative day 1 or 2 if they have undergone an elective colorectal operation for cancer.
Methods
The 2012 American College of Surgeons National Surgical Quality Improvement Program dataset was used. The study included patients who underwent elective colorectal cancer surgery and were discharged on postoperative day (POD) 1 or 2 (expedited early discharge) versus POD 3 or 4 (standard early discharge). Patients who had metastases, concurrent procedures including ostomy creation, or died during admission were excluded. Primary outcomes were 30-day adverse events (serious complications, mortality and reoperations) and readmission rates, which were analyzed using multivariable regression.
Results
A total of 305 and 2277 patients were identified in the expedited and standard early discharge groups, respectively. There were 6 (1.97 %) adverse events and 16 (5.56 %) readmissions in the expedited group, compared to 59 (2.59 %) and 135 (6.24 %) in the standard group. No statistical difference was found between the cohorts with respect to 30-day adverse events (OR 0.93, p = 0.87, 95 % CI [0.41–2.12]) or readmission rate (OR 1.03, p = 0.90, 95 % CI [0.61–1.76]).
Conclusion
Patients discharged by POD 2 after elective oncologic colon resections did not have significantly more adverse events or readmissions compared to patients discharged later. Select patients may be safely discharged earlier.
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References
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149(6):830–840
Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ (2012) Towards optimizing perioperative colorectal care: outcomes for 1000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg 203(3):353–356
Esteban F, Cerdan FJ, Garcia-Alonso M et al (2014) A multicentre comparison of a fast track or conventional postoperative protocol following laparoscopic or open elective surgery for colorectal cancer surgery. Colorectal Dis 16(2):134–140
Geltzeiler CB, Rotramel A, Wilson C, Deng L, Whiteford MH, Frankhouse J (2014) Prospective study of colorectal enhanced recovery after surgery in a community hospital. JAMA Surg 149(9):955
Keane C, Savage S, Mcfarlane K, Seigne R, Robertson G, Eglinton T (2012) Enhanced recovery after surgery versus conventional care in colonic and rectal surgery. ANZ J Surg 82(10):697–703
Gash KJ, Greenslade GL, Dixon AR (2012) Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates. Colorectal Dis 14(10):1287–1290
Kelly KN, Iannuzzi JC, Aquina CT et al (2015) Timing of discharge: a key to understanding the reason for readmission after colorectal surgery. J Gastrointest Surg 19(3):418–428
Rossi G, Vaccarezza H, Vaccaro CA et al (2013) Two-day hospital stay after laparoscopic colorectal surgery under an enhanced recovery after surgery (ERAS) pathway. World J Surg 37(10):2483–2489
Lawrence JK, Keller DS, Samia H et al (2013) Discharge within 24 to 72 hours of colorectal surgery is associated with low readmission rates when using enhanced recovery pathways. J Am Coll Surg 216(3):390–394
Lemanu DP, Singh PP, Stowers MDJ, Hill AG (2014) A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis 16(5):338–346
American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP): participants. http://site.acsnsqip.org/participants/. Last Accessed 16 July 2015
Khuri SF, Daley J, Henderson W et al (1997) Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 185(4):315–327
Khuri SF, Henderson WG, Daley J et al (2007) The patient safety in Surgery Study: background, study design, and patient populations. J Am Coll Surg 204(6):1089–1102
Vittinghoff E, Shiboski SC, Glidden DV, McCulloch CE (2005) Selecting predictors on statistical grounds. In: Gail M, Krickeberg K, Samet J, Tsiatis A, Wong W (eds) Regression methods in biostatistics: linear, logistic, survival, and repeated measures models, p 141
Hoffman RL, Bartlett EK, Ko C, Mahmoud N, Karakousis GC, Kelz RR (2014) Early discharge and readmission after colorectal resection. J Surg Res 190(2):579–586
King PM, Blazeby JM, Ewings P et al (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93(3):300–308
Basse L, Thorbøl JE, Løssl K, Kehlet H, Senagore A (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47(3):271–278
Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery. Ann Surg 254(6):868–875
De Hoyos A, Southard C, DeCamp MM (2012) Perioperative smoking cessation. Thorac Surg Clin 22(1):1–12
Lindström D, Sadr Azodi O, Wladis A et al (2008) Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248(5):739–745
Møller AM, Villebro N, Pedersen T, Tønnesen H (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 359(9301):114–117
Kirchhoff P, Clavien P-A, Hahnloser D (2010) Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg 4(1):5
Panis Y (2008) A multivariate analysis of potential risk factors for intra- and post-operative complications in 1316 elective laparoscopic colorectal procedures. Colon Rectum 2(4):239
Lipska MA, Bissett IP, Parry BR, Merrie AEH (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76(7):579–585
Tevis SE, Weber SM, Kent KC, Kennedy GD (2015) Nomogram to predict postoperative readmission who undergo general surgery. JAMA Surg 150(6):5015–5510
Author contributions
Okrainec, Jackson, and Quereshy contributed to study concept and design. Yuen and Elnahas were involved in acquisition of data. Yuen, Elnahas, and Azin were involved in analysis and interpretation of data. Yuen and Elnahas drafted the manuscript. Azin, Okrainec, Jackson, and Quereshy critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript to be published.
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Authors Andrew Yuen, Ahmad Elnahas, Arash Azin, Allan Okrainec, Timothy D. Jackson, and Fayez A. Quereshy have no conflicts of interest to disclose. No external sources of funding were used for this study or its publication.
Additional information
American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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Yuen, A., Elnahas, A., Azin, A. et al. Is expedited early discharge following elective surgery for colorectal cancer safe? An analysis of short-term outcomes. Surg Endosc 30, 3904–3909 (2016). https://doi.org/10.1007/s00464-015-4696-6
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DOI: https://doi.org/10.1007/s00464-015-4696-6