Evaluating Outcomes of Same Day Discharge After Minimally Invasive Colectomy: A Nationwide Analysis
Wardah Rafaqat, Abiha Abdullah, May Abiad, Matthew McEvoy, Shannon McChensey, Hanjoo Lee, Baryalay Khan, Alexander T. Hawkins, Aimal KhanBackground
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.