Rethinking postoperative care: same-day ileostomy closure discharge improves patient outcomes

Abstract

BackgroundThe evolution of enhanced recovery protocols (ERPs) in colon and rectal surgery has led to the development of same-day discharge (SDD) procedures for selected patients. Early discharge following diverting loop ileostomy (DLI) closure was first described in 2003. However, its widespread adoption remains limited, with SDD accounting for only 3.2% of all DLI closures in 2005-2006, according to ACS-NSQIP database, and rising to just 4.1% by 2016. Aim of the study was to compare the outcomes of SDD DLI closure with those of DLI closure following the standard ERP. MethodsA retrospective case-matched study compared 125 patients undergoing SDD DLI closure to 250 patients undergoing DLI closure following the standard ERP based on age (± 1 year), sex, ASA score, BMI, surgery date (± 2 months), underlying disease, and hospital site. The primary outcome was comparative 30-day complication rates. ResultsPatients in the traditional ERP group received more intraoperative fluids (1221.1 ± 416.6 vs. 1039.0 ± 368.3ml, P<0.001) but had similar estimated blood loss. Ten patients (8%) in the SDD-ERP group failed same-day discharge. The 30-day postoperative complication rate was significantly lower in the SDD group (14.8%) compared to the standard ERP group (25.7%, P=0.025). This difference was primarily driven by a lower incidence of ileus in the SDD group (9.6% vs. 14.8%, P=0.034). There were no significant differences in readmission rate (9.6% of SDD-ERP vs. 9.2% of standard ERP, P=0.900) and re-operation rates (3.2% of SDD-ERP vs. 2.4% of standard ERP, P=0.650). ConclusionSDD ileostomy closure is a safe, feasible, and effective procedure associated with fewer complications than the present study's standard ERP. This could represent a new standard of care. Further prospective trials are required to confirm the findings of this study. Data availability statementData supporting the research are available upon request to protect the privacy of study participants.