A retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway.

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There is increasing evidence to support discharge prior to gastrointestinal recovery following colorectalsurgery. Furthermore, many patients are discharged early despite being excluded from an ambulatory colectomy pathway. The objective of this study was to determine the outcomes of patients discharged early following laparoscopic colectomy in an enhanced recovery pathway (ERP). Aretrospective review of all adult patients undergoingelectivelaparoscopic colectomy at a single university-affiliated colorectal referral center(08/2017-06/2021)was performed.Patients were included if they had undergone elective laparoscopic colectomyor ileostomyclosure andexcluded if they had been enrolled in an ambulatory colectomy pathway. Patients were then divided into three groups: LOS=1 day, LOS 2-3 days, and LOS 4+ days. The main outcomeswere30-day emergencyroom (ER)visitsand readmissions. Reasons for inpatient stay per post-operative day (POD) werealso recorded. A total of497 patients were included[LOS1 n=63 (13%), LOS2-3 n=284 (57%), and LOS4+ n=150 (30%)]. There were no differences in patient characteristics, diagnosis, or procedure between the groups. Patients were discharged with gastrointestinal recovery (GI-3) in 54% LOS1 vs. 98% LOS2-3 vs. 100% LOS4+ (p<0.001). Shorter procedure duration, transversus abdominus plane block, and lower opioid requirements were associated with shorter LOS (p<0.001). The absence of flatus was the most common reason to keep patients hospitalized:61%onPOD1, 21%onPOD2,and8%onPOD3(p<0.001).There were no differences in30-dayemergencyvisits,orreadmissionbetween the groups.In the LOS1 group, there were no differences in outcomes between patients with full return of bowel function at discharge compared to those without. Discharge onPOD1was not associated withincreased emergency department use, complications, or readmissions.Importantly, full return of bowel function at discharge did not affect outcomes. There may be potential to expand eligibility criteria for ambulatory colectomy protocol.