Is expedited early discharge following elective surgery for colorectal cancer safe? An analysis of short-term outcomes.

Abstract

Enhanced recovery pathways have become standard practice after elective colorectal surgery to improve postoperative care while reducing length of stay in hospital. However, there is concern that early discharge may result in increased rates of adverse events including readmission. This study aims to determine whether it is safe to discharge patients on postoperative day 1 or 2 if they have undergone an elective colorectal operation for cancer. The 2012 American College of Surgeons National Surgical Quality Improvement Program dataset was used. The study included patients who underwent elective colorectal cancer surgery and were discharged on postoperative day (POD) 1 or 2 (expedited early discharge) versus POD 3 or 4 (standard early discharge). Patients who had metastases, concurrent procedures including ostomy creation, or died during admission were excluded. Primary outcomes were 30-day adverse events (serious complications, mortality and reoperations) and readmission rates, which were analyzed using multivariable regression. A total of 305 and 2277 patients were identified in the expedited and standard early discharge groups, respectively. There were 6 (1.97%) adverse events and 16 (5.56%) readmissions in the expedited group, compared to 59 (2.59%) and 135 (6.24%) in the standard group. No statistical difference was found between the cohorts with respect to 30-day adverse events (OR 0.93, p=0.87, 95% CI [0.41-2.12]) or readmission rate (OR 1.03, p=0.90, 95% CI [0.61-1.76]). Patients discharged by POD 2 after elective oncologic colon resections did not have significantly more adverse events or readmissions compared to patients discharged later. Select patients may be safely discharged earlier.