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Beyond enhanced recovery after surgery (ERAS): Evolving minimally invasive colectomy from multi-day admissions to same-day discharge

Published:January 21, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.024

      Highlights

      • Despite advances of ERAS, colectomy still usually demands 1–2 day inpatient stay.
      • Early, limited data exists on same-day-discharge (SDD) after colectomy.
      • We analyze longitudinal outcomes after starting routine SDD during the era.
      • In the last year, over half of patients underwent SDD successfully.
      • Multi-disciplinary pathways and advanced robotic surgical techniques were crucial.

      Abstract

      Introduction

      Early discharge is increasingly important in the resource-limited COVID era. Some groups have reported early experiences with same day discharge (SDD) after colectomy. We implemented a routine SDD protocol and report the evolution in our program's outcomes.

      Methods

      We studied a retrospective cohort of robotic colorectal surgeries from 2016 to 2022. Colectomies were analyzed as a sub-group and stratified by year.

      Results

      The cohort comprised 535 cases, of which 483 were colectomies. Annual case volume increased from 58 to 180 cases (p < 0.001). Operative console time concordantly decreased by 33% (p < 0.001). Average length of stay decreased from five to one days. By 2022, 58% of colectomies were selectively discharged on the same day of surgery. Complication and readmission rates remained constant.

      Conclusions

      SDD is feasible and safe in selected patients. We illustrate the practical evolution of a surgical practice toward routine SDD, and discuss the factors we found critical to this transition.

      Keywords

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