Outcome of Discharge Within 24 to 72 Hours After Laparoscopic Colorectal Surgery

Purpose Although laparoscopic colorectal surgery may permit early recovery and discharge from hospital, short lengths of stay are not routinely achieved. This is partly because accelerated recovery programs with early discharge are associated with high readmission and complication rates, especially after open colorectal surgery. Methods This study was designed to examine safety and outcomes after laparoscopic colectomy in cases discharged within 72 hours of surgery. A total of 118 consecutive patients (mean age 60 years) underwent elective laparoscopic colectomy by a single surgeon. An accelerated recovery program included an overnight intravenous patient- controlled analgesia pump, diet and oral analgesia on postoperative Day 1, and standardized discharge criteria. Results Mean body mass index was 28.5 (range, 20–45), and mean operative time was 142 minutes with no mortality. Median stay was 3 days, and 20 percent had a complication within 30 days. Eighty-two patients (70 percent) were discharged within 72 hours of surgery (10 Day 1; 46 Day 2; 26 Day 3). Patients were grouped and analyzed by day of discharge. Discharge on Days 1 to 2 was associated with significantly lower complication rates than seen for the overall group. Although patients discharged on Days 1 to 2 had the lowest readmission rate, this did not reach statistical significance. Conclusions Readmission and complication rates are low in patients discharged on Days 1, 2, or 3 after laparoscopic colectomy when using standardized postoperative care protocols and standardized discharge criteria. Dr. Delaney received a research grant and is a consultant to U.S. Surgical, Ethicon and Adolar. Read at the meeting of the America Society of Colon and Rectal Surgeons, June 2 to 6, St. Louis, Missouri. Reprints are not available.