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Safety and Feasibility of ≤24-h Short-Stay Right Colectomies for Primary Colon Cancer

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Abstract

Background

Hospital length of stay (LOS) has been used as a surgical quality metric. This study seeks to determine the safety and feasibility of right colectomy as a ≤24-h short-stay procedure for colon cancer patients.

Methods

This was a retrospective cohort study using the ACS-NSQIP database and its Procedure Targeted Colectomy database (2012–2020). Adult patients with colon cancer who underwent right colectomies were identified. Patients were categorized into LOS  ≤1 day (≤24-h short-stay), LOS 2–4 days, LOS 5–6 days, and LOS ≥7 days groups. Primary outcomes were 30-day overall and serious morbidity. Secondary outcomes were 30-day mortality, readmission, and anastomotic leak. The association between LOS and overall and serious morbidity was assessed using multivariable logistic regression.

Results

19,401 adult patients were identified, with 371 patients (1.9%) undergoing short-stay right colectomies. Patients undergoing short-stay surgery were generally younger with fewer comorbidities. Overall morbidity for the short-stay group was 6.5%, compared to 11.3%, 23.4%, and 42.0% for LOS 2–4 days, LOS 5–6 days, and LOS ≥7 days groups, respectively (p < 0.001). There were no differences in anastomotic leak, mortality, and readmission rates in the short-stay group compared to patients with LOS 2–4 days. Patients with LOS 2–4 days had increased odds of overall morbidity (OR 1.71, 95% CI 1.10–2.65, p = 0.016) compared to patients with short-stay but no differences in odds of serious morbidity (OR 1.20, 95% CI 0.61–2.36, p = 0.590).

Conclusions

 ≤24-h short-stay right colectomy is safe and feasible for a highly-select group of colon cancer patients. Optimizing patients preoperatively and implementing targeted readmission prevention strategies may aid patient selection.

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Acknowledgements

Sophia Y. Chen and Shannon R. Radomski received financial support from National Cancer Institute (NCI) Grant 5T32CA126607-12. Mr. Edwin Lewis provided generous support of Dr. Efron's Department of Surgery Research Fund. The Nicholl Family Foundation provided generous support of the Johns Hopkins Division of Colorectal Surgery Research Fund. The authors would like to acknowledge the Johns Hopkins Surgery Center for Outcomes (JSCOR) for supporting this study.

Funding

Sophia Y. Chen and Shannon R. Radomski received financial support from National Cancer Institute (NCI) Grant 5T32CA126607-12. Mr. Edwin Lewis provided generous support of Dr. Efron's Department of Surgery Research Fund. The Nicholl Family Foundation provided generous support of the Johns Hopkins Division of Colorectal Surgery Research Fund.

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Authors and Affiliations

  1. Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Sophia Y. Chen, Shannon N. Radomski, Miloslawa Stem, Brian D. Lo, Bashar Safar, Jonathan E. Efron & Chady Atallah

  2. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Brian D. Lo

  3. Department of Surgery, Division of Colon and Rectal Surgery, NYU Langone Health, 530 First Ave, Suite 7V, New York, NY, 10016, USA

    Bashar Safar & Chady Atallah

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  1. Sophia Y. Chen
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  2. Shannon N. Radomski
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  3. Miloslawa Stem
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  4. Brian D. Lo
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  5. Bashar Safar
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  6. Jonathan E. Efron
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  7. Chady Atallah
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Contributions

Study design: SYC, SNR, MS, BDL, JEE, BS, CA. Data acquisition and analysis: SYC, SNR, MS, BDL. Interpretation of data: SYC, SNR, MS, BDL, JEE, BS, CA. Drafting work: SYC, SNR, MS, BDL. Critical revision: SYC, SNR, MS, BDL, JEE, BS, CA. Final approval/accountability: SYC, SNR, MS, BDL, JEE, BS, CA.

Corresponding author

Correspondence to Chady Atallah.

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Chen, S.Y., Radomski, S.N., Stem, M. et al. Safety and Feasibility of ≤24-h Short-Stay Right Colectomies for Primary Colon Cancer. World J Surg 47, 2267–2278 (2023). https://doi.org/10.1007/s00268-023-07041-1

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  • DOI: https://doi.org/10.1007/s00268-023-07041-1

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