Early Discharge after Uncomplicated Elective Colectomy and Risk of Post-Discharge Complication.

BACKGROUND: This was a retrospective cohort study of adult patients undergoing uncomplicated elective colectomy using the National Surgical Quality Improvement Program database from January 2012 to December 2019. A colectomy is deemed uncomplicated if there was no complication reported during the hospitalization. The objective of this study was to examine the association between discharge timing and post-discharge complications in patients who undergo uncomplicated elective colectomy.

METHODS: Patients were stratified into an early discharge group if their length of postoperative hospitalization was ≤3days for laparoscopic or robotic approaches, or ≤5days for the open approach, and otherwise into delayed discharge groups. The association between early discharge and any post-discharge complication was examined using unadjusted logistic regression after propensity score matching between early and delayed discharge groups.

RESULTS: Of the 113,940 patients included, 77,979, 15,877, and 20,084 patients underwent uncomplicated laparoscopic, robotic, and open colectomy, respectively. After propensity score matching, the odds of a post-discharge complication were lower for the early discharge group in laparoscopic (OR 0.73, 95%-CI 0.68-0.79) and robotic (OR 0.63, 95%-CI 0.52-0.76) approaches, and not different in the open approach (OR 1.02, 95%-CI 0.91-1.15). There were no clinically meaningful differences in the risk of return to the operating room for all surgical approaches.

CONCLUSIONS: Early discharge after uncomplicated colectomy appears to be safe and is associated with lower odds of post-discharge complications in minimally invasive approaches. Our findings suggest that surgical teams practice sound clinical judgments on selecting patients who benefit from early discharge.