QS303 - Maximizing Successful Same Day Discharge Colectomies: A Single Institutional Retrospective Review

Purpose/Background: The growth of enhanced recovery programs and minimization of narcotic use by way of multimodal pain therapy has greatly reduced hospital length of stay. Advancements have been made to where same day discharge (SDD) after colectomies shows to be a viable disposition strategy. Our aim is to provide insight into the perioperative care and patient characteristics that constituted the cohort that were successful in SDD.

Methods/Interventions: We performed a retrospective data analysis of colectomy patients preoperatively deemed to be SDD candidates from August 2019 to August 2023. Analysis involved comparison of patient characteristics, perioperative factors, and postoperative complications between successful SDD patients and postoperatively admitted patients.

Results/Outcomes: We reviewed 157 patients that were preoperatively determined to be candidates for SDD after colectomy. The most common procedure was low anterior resection (56%), followed by right hemicolectomy (28%). Nearly all cases were performed with minimally invasive surgery (98%). SDD was successful in 113 patients (72%). Patient factors including age, BMI, presence of diabetes, anticoagulation, malignancy indicated procedure, and history of prior abdominal surgery were statistically equivalent between SDD and postoperatively admitted patients. Successful SDD patients tended to be male (50% vs 30%, p = 0.021), undergo shorter operation time (168 vs 200 minutes, p = 0.006), and require less narcotics (0.49 vs 2.5 morphine equivalent dose, p = 0.0002). Estimated blood loss ≤ 100 mL yielded 76% SDD patients compared to 31% who lost more than 100 mL (p = 0.0015). Postoperative complications did not statistically significantly differ between SDD and admitted patients. Anastomotic leak rate in SDD patients was 1.8% vs 2.3% (p = 1), surgical site infection in SDD patients was 2.7% vs 9.1% (p = 0.097), post-discharge ED visits in SDD patients was 12% vs 16% (p = 0.44), and the 30-day readmission rate in SDD patients was 8% vs 9% (p = 0.76). Postoperatively admitted patients had an average length of stay of two days.

Conclusion/Discussion: Successful SDD after colectomy is feasible in almost 3 of 4 patients with non-inferior complication rates. The SDD strategy relies on minimally invasive surgery, minimal operating time, and minimal narcotic use by way of multimodal pain therapy.