Skip to main content

Advertisement

SpringerLink
Log in

Twenty-Three-Hour-Stay Colectomy Without Increased Readmissions: An Analysis of 1905 Cases from the National Surgical Quality Improvement Program

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Isolated case series from highly specialized centers suggest the feasibility of a 23-h hospital stay after colectomy. We sought to determine preoperative variables associated with discharge within 23 h after colectomy to identify patients best suited for a short-stay model.

Methods

The American College of Surgeons NSQIP Colectomy-Targeted database was used to identify patients who underwent elective colectomy from 2012 to 2017. All cases with missing length of stay or inpatient death were excluded. Patients with a postoperative hospital stay ≤1 day were identified. Univariate and multivariate analyses were conducted to identify factors associated with early discharge.

Results

A total of 1905 patients were discharged within 23 h after surgery (1.6%). These patients were noted to be younger (59 versus 61 years, p < 0.001) and less likely to have insulin-dependent diabetes (3.0 versus 4.4%, p < 0.001), preoperative dyspnea (2.2 versus 6.0%, p < 0.001), COPD (3.0 versus 4.2%, p = 0.011), and hypertension (40.7 versus 46.9%, p < 0.001) than patients who stayed longer. Shorter operative time (OR 0.986, 95% CI 0.985–0.987, p < 0.001), minimally invasive techniques (OR 2.969, 95% CI 2.686–3.282, p < 0.001), lack of ostomy (OR 0.614, 95% CI 0.478–0.788, p < 0.001), and lack of ureteral stenting (OR 0.641, 95% CI 0.500–0.821, p < 0.001) were associated with early discharge in multivariable analysis. There was no increased incidence of readmission in patients discharged within 23 h.

Conclusions

Twenty-three-hour-stay colectomy is feasible on a national level and does not result in an increased incidence of readmission. Patients undergoing elective procedures without significant medical comorbidities may be eligible for early discharge. Preoperative factors may be used to select patients best suited for this short-stay model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Levy BF, Scott MJP, Fawcett WJ, Rockall TA (2009) 23-Hour-stay laparoscopic colectomy. Dis Colon Rectum 52(7):1239–1243

    Article  CAS  Google Scholar 

  2. Kalish RL, Daley J, Duncan CC, Davis RB, Coffman GA, Iezzoni LI (1995) Costs of potential complications of care for major surgery patients. Am J Med Qual 10(1):48–54

    Article  CAS  Google Scholar 

  3. Molloy LB, Martin BI, Moschetti WE, Jevsevar DS (2017) Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013. J Bone Joint Surg 99(5):402

    Article  Google Scholar 

  4. Collins TC, Daley J, Henderson WH, Khuri SF (1999) Risk factors for prolonged length of stay after major elective surgery. Annals of Surgery 230(2):251

    Article  CAS  Google Scholar 

  5. Price BA et al (2017) Accelerated enhanced recovery following minimally invasive colorectal cancer surgery (RecoverMI ): a study protocol for a novel randomised controlled trial. BMJ Open 7(7):015960

    Article  Google Scholar 

  6. Haverkamp MP, de Roos MAJ, Ong KH (2012) The ERAS protocol reduces the length of stay after laparoscopic colectomies. Surgical Endoscopy 26(2):361–367

    Article  CAS  Google Scholar 

  7. Lawrence JK et al (2013) Discharge within 24 to 72 hours of colorectal surgery is associated with low readmission rates when using enhanced recovery pathways. Journal of the American College of Surgeons 216(3):390–394

    Article  Google Scholar 

  8. Cologne K et al (2016) Factors associated with a short (<2 days) or long (>10 days) length of stay after colectomy: a multivariate analysis of over 400 patients. Am Surg 82:960–963

    PubMed  Google Scholar 

  9. User Guide for the 2017 ACS NSQIP procedure targeted participant use data file. https://www.facs.org/-/media/files/quality-programs/nsqip/pt_nsqip_puf_userguide_2017.ashx?la=en

  10. Schoetz D et al (1997) Ideal’ length of stay after colectomy: whose ideal? Dis Colon Rectum 40:806–810

    Article  Google Scholar 

  11. Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen L (2015) Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol 16(1):806–810

    Article  Google Scholar 

  12. Stephen AE, Berger DL (2003) Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection. Surgery 133(3):277–282

    Article  Google Scholar 

  13. Wick EC, Grant MC, Wu CL (2017) Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques. JAMA Surgery 152(7):691–697

    Article  Google Scholar 

  14. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JJA, Wu CL (2003) Efficacy of Postoperative Epidural Analgesia. JAMA 290(18):2455–2463

    Article  CAS  Google Scholar 

  15. Pöpping DM et al (2014) Impact of Epidural Analgesia on Mortality and Morbidity After Surgery. Annals of Surgery 259(6):1056–1067

    Article  Google Scholar 

  16. Sporer SM, Rogers T (2016) Postoperative pain management after primary total knee arthroplasty: the value of liposomal bupivacaine. J Arthroplast 31(11):2603–2607

    Article  Google Scholar 

  17. Ho VP et al (2011) Differing risk factors for incisional and organ/space surgical site infections following abdominal colorectal surgery. Dis Colon Rectum 54(7):818–825

    Article  Google Scholar 

  18. Longo W et al (2000) Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 43:83–91

    Article  CAS  Google Scholar 

  19. Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49(7):1011–1017

    Article  Google Scholar 

  20. Slieker JC et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage. Archives of Surgery 147(5):447–452

    Article  Google Scholar 

  21. Francis NK et al (2015) Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Disease 17(7):528–535

    Article  Google Scholar 

  22. Kulaylat AN, Dillon PW, Hollenbeak CS, Stewart DB (2015) Determinants of 30-d readmission after colectomy. J Surg Res 193(2):528–535

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02108, USA

    Lily V. Saadat, David A. Mahvi, Joshua S. Jolissaint, Jason S. Gold & Edward E. Whang

  2. Department of Anesthesiology, University of California, San Diego, CA, USA

    Rodney A. Gabriel

  3. Center for Perioperative Research, Brigham and Women’s Hospital, Boston, MA, USA

    Richard Urman & Edward E. Whang

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Richard Urman

  5. Department of Surgery, VA Boston Healthcare System, West Roxbury, MA, USA

    Jason S. Gold

Authors
  1. Lily V. Saadat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David A. Mahvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joshua S. Jolissaint
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodney A. Gabriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard Urman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason S. Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edward E. Whang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lily V. Saadat.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saadat, L.V., Mahvi, D.A., Jolissaint, J.S. et al. Twenty-Three-Hour-Stay Colectomy Without Increased Readmissions: An Analysis of 1905 Cases from the National Surgical Quality Improvement Program. World J Surg 44, 947–956 (2020). https://doi.org/10.1007/s00268-019-05257-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05257-8

Search

Navigation