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Identification of patients eligible for discharge within 48 h of colorectal resection

British Journal of Surgery Apr 03, 2020

Grass F, Hübner M, Mathis KL, et al. - Researchers sought to ascertain significant factors associated with a short hospital stay (less than 48 h) so that patients eligible for a 48‐h stay after colorectal resection could be identified and early discharge planning could be guided. Consecutive patients who had undergone major elective colorectal resection for benign or malignant pathology within a comprehensive enhanced recovery pathway from 2011 to 2017 were assessed in this bi‐institutional retrospective cohort study. Discharge within 48 h was reported in 686 of 5,122 patients (13.4%). A short hospital stay was observed in independent association with age below 60 years, ASA grade less than III, restrictive fluid management (less than 3000 ml on day of surger), duration of surgery less than 180 min, minimally invasive approach and wound contamination grade below III, whereas a decreased likelihood of early discharge was observed in correlation with cancer diagnosis and malnutrition (BMI below 18 kg/m2). Patients with a 48‐h stay experienced fewer overall (10·8% vs 30·6% in those with a longer stay) and fewer severe (2·6% vs 10·2%) complications, and had a lower readmission rate (9·0% vs 11·8%). Findings support the safety of performing early discharge of selected patients with no increase in postoperative morbidity or readmission rates. With logistical optimization, outpatient colorectal surgery should be feasible in these patients on a large scale.

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