Day-case stoma, surgery: Is it feasible?

Abstract

The National Health Service (NHS) Modernisation Agency has identified ten high impact changes for health organisations to adopt in order to improve their service. Top of this list is increasing day-surgery rates. The basket of interventions offered as short-stay procedures will have to increase to achieve this target. The aim of this study was to investigate whether it is feasible to offer fashioning or reversal of loop stomas as a short-stay procedure. Consecutive patients needing stoma fashioning or reversal were offered surgery as a day-case. All were recruited from a single colorectal consultant's caseload. Patients scheduled for stoma formation were taught how to manage the stoma by a specialist nurse prior to hospital admission. The stoma nurse then visited all patients at home one day after discharge. Laparoscopic-assisted techniques, opiate avoidance and early mobilisation were included in the management protocol. Data relating to patient demographics, length of stay and complications were collected prospectively. Results of continuous variables were presented as median and interquartile ranges (IQRs). All patients offered day-surgery accepted it readily. A total of twelve patients (M:F, 5:7) with a median (IQR) age of 70 (63-74) years were recruited. Seven had laparoscopically assisted loop ileostomy formation while five underwent loop stoma reversal (four loop ileostomies, one transverse colostomy). Four out of twelve patients were discharged the same day and 11/12 patients were home within 23 hours of admission. One patient needed admission for 72 hours for social reasons. None of the patients required readmission, and there were no observed complications associated with early discharge. With the appropriate supportive set up, 23-hour stoma surgery is indeed feasible. Day-case procedures are possible in some, however, as with all short-stay surgery, careful patient selection is required.