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Session: ePoster Monitor 3-Quality and Cost 1

eP140 - Early Discharge After Enhanced Recovery Colectomy Does Not Increase Emergency Department Visits and Readmissions: A Single Institution Analysis

Sunday, June 2, 2024
8:00 AM – 8:05 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Katherine Baur, MD (she/her/hers)

    Surgical Resident
    Trinity Health Ann Arbor
    Trinity Health Ann Arbor
    Ypsilanti, MI, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • ES

    Evan M. Sood, BS

    Medical Student
    University at Buffalo - Jacobs School of Medicine and Biomedical Sciences
    Buffalo, New York, United States

    Disclosure information not submitted.

  • MH

    Marianne Huebner, PhD

    Professor
    Michigan State University
    East Lansing, Michigan, United States

    Disclosure information not submitted.

  • NK

    Nivya Kolli, PharmD, PhD

    Project Manger
    Trinity Health, Ann Arbor
    Ypsilanti, Michigan, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Robert K. Cleary, MD

    Program Director Colon and Rectal Surgery
    Trinity Health Ann Arbor
    Trinity Health
    Ann Arbor, Michigan, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no relevant relationships with ineligible companies.

Purpose/Background: When considering same-day discharge after colorectal surgery in enhanced recovery pathways, it would be important to know if early discharge is associated with increased emergency department (ED) visits and readmissions. This study is to determine if discharge on postoperative days (POD) one or two is associated with increased rates of ED visits and hospital readmissions after left and right colectomy.Methods/Interventions: This is a single institution analysis of a prospectively maintained institutional colorectal surgery database between 07/01/2018 and 07/15/2022. The primary outcomes were ED visit and readmission rates for enhanced recovery open and minimally invasive right and left colectomy using logistic regressions models.Results/Outcomes: 820 patients met inclusion criteria; mean age 62.8 years; 47.4% ASA-3, and 83.2% had a minimally invasive surgical approach. Hospital length-of-stay decreased over the study period. There were significant differences in discharge-day by diagnosis - 58.5% of patients with Crohn’s disease were discharged on POD≥4 and 21.6% of those with benign colon neoplasia were discharged on POD 0-1 (p < 0.001). ED visits occurred in 12.9% of the study population and were not significantly different between discharge-day groups (p=0.096). Overall readmission rate was 8.5% and significantly different between discharge-day groups (0% POD-0 vs 8.3% POD-1 vs 5.8% POD-2 vs 6.9% POD-3 vs 12.9% POD≥4, p=0.041). Logistic regression showed that ED visits and readmissions for longer discharge-days (POD-2, POD-3, POD≥4) were not significantly different than POD-0-1. Readmission diagnoses for the study population were higher for ileus (17.1%) and SSI III (22.9%) than for AKI (1.4%) and SSI I/II (1.4%). Readmissions were not related to discharge day of the week (p=0.494).Conclusion/

Discussion: Early discharge after left and right colectomy is not associated with increased rates of ED visits and readmissions. Same-day discharge may be feasible in selected enhanced recovery patients. Risks and benefits associated with same-day discharge require further investigation.Emergency Department Visits and Readmissions