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

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

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.

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References

  1. Behrns KE, Kircher AP, Galanko JA, Brownstein MR, Koruda MJ. Prospective randomized trial of early initiation and hospital discharge on a liquid diet following elective intestinal surgery. J Gastrointest Surg 2000;4:217–21.

    Article  PubMed  CAS  Google Scholar 

  2. Basse L, Hjort Jakobsen S, Billesbolle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000;232:51–7.

    Article  PubMed  CAS  Google Scholar 

  3. Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson A, Remzi FH. Fast-track postoperative management protocol for patients with high comorbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001;88:1533–8.

    Article  PubMed  CAS  Google Scholar 

  4. Di Fronzo LA, Cymerman J, O’Connell TX. Factors affecting early postoperative feeding following elective open colon resection. Arch Surg 1999;134:941–5.

    Article  PubMed  Google Scholar 

  5. Basse L, Thorbol JE, Lossl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004;47:271–7.

    Article  PubMed  Google Scholar 

  6. Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective randomized, controlled trial between a pathway of Controlled Rehabilitation with Early Ambulation and Diet (CREAD) and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 2003;46:851–9.

    Article  PubMed  Google Scholar 

  7. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW. Case matched comparison of clinical and financial outcome after laparoscopic or open colectomy. Ann Surg 2003;238:67–72.

    Article  PubMed  Google Scholar 

  8. Senagore AJ, Duepree HJ, Delaney CP, Brady K, Fazio VW. Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 2003;46:503–9.

    Article  PubMed  Google Scholar 

  9. Zutshi M, Delaney CP, Senagore AJ, et al. Randomized controlled trial comparing the Controlled Rehabilitation with Early Ambulation and Diet (CREAD) pathway vs. CREAD with pre-emptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 2005;189:268–72.

    Article  PubMed  Google Scholar 

  10. Zutshi M, Delaney CP, Senagore AJ, Fazio VW. Shorter hospital stay associated with fasttrack postoperative care pathways and laparoscopic intestinal resection are not associated with increased physical activity. Colorectal Dis 2004;6:477–80.

    Article  PubMed  CAS  Google Scholar 

  11. Senagore AJ, Delaney CP. A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. Am J Surg 2006;191:377–80.

    Article  PubMed  Google Scholar 

  12. Senagore AJ, Delaney CP, Mekhail N, Fazio VW. Prospective randomized controlled trial evaluating epidural anesthesia/analgesia in laparoscopic segmental colectomy. Br J Surg 2003;90:1195–9.

    Article  PubMed  CAS  Google Scholar 

  13. Braga M, Gignali A, Gianotti L, et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 2002;236:759–67.

    Article  PubMed  Google Scholar 

  14. Jansson M, Bjöholt I, Carlsson CP, et al. Randomised clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 2004;91:409–17.

    Article  Google Scholar 

  15. Leung KL, Kwork SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004;363:1187–97.

    Article  PubMed  Google Scholar 

  16. Asao T, Kuwano H, Nakamura J, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002;195:30–2.

    Article  PubMed  Google Scholar 

  17. Schwenk W, Haase O, Neudecker J, Muller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2005;20:CD003145.

    Google Scholar 

  18. Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 2004;91:1111–24.

    Article  PubMed  CAS  Google Scholar 

  19. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 2006;93:921–8.

    Article  PubMed  CAS  Google Scholar 

  20. Tjandra JJ, Chan MK. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 2006;8:375–88.

    Article  PubMed  CAS  Google Scholar 

  21. Guller U, Jain N, Hervey S, Purves H, Pietrobon R. Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 2003;138:1179–86.

    Article  PubMed  Google Scholar 

  22. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 2005;241:416–23.

    Article  PubMed  Google Scholar 

  23. Kiran RP, Delaney CP, Senagore AJ, Fazio VW. Prediction and outcome of readmission after intestinal resection. J Am Coll Surg 2004;198:877–83.

    Article  PubMed  Google Scholar 

  24. Delaney CP, Senagore AJ, Viscusi ER, et al. Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from three randomized controlled trials. Am J Surg 2006;191:315–9.

    Article  PubMed  Google Scholar 

  25. Kariv Y, Wang W, Senagore AJ, Hammel J, Fazio VW, Delaney CP. Multivariate analysis of factors associated with readmission to hospital after intestinal surgery. Am J Surg 2006;191:364–71.

    Article  PubMed  Google Scholar 

  26. Delaney CP. Postoperative ileus: introduction, definitions, and clinical importance. Semin Colorectal Surg 2005;16:182–3.

    Article  Google Scholar 

  27. Wolff BG, Weese JL, Ludwig KA, et al. Postoperative ileus related morbidity profile in patients treated with alvimopan after bowel resection. J Am Coll Surg 2007;204:609–16.

    Article  PubMed  Google Scholar 

  28. Delaney CP, Wolff BG, Viscusi ER, et al. Alvimopan, for postoperative ileus following bowel resection: a pooled analysis of phase III studies. Ann Surg 2007;245:355–63.

    Article  PubMed  Google Scholar 

  29. Noblett SE, Snowden CP, Shenton BK, Horgan AF. Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 2006;93:1069–76.

    Article  PubMed  CAS  Google Scholar 

  30. Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc 2007;21:247–52.

    Article  PubMed  CAS  Google Scholar 

  31. Senagore AJ, Brannigan A, Kiran RP, Brady KM, Delaney CP. Diagnosis related group assignment in laparoscopic and open colectomy: financial implications for payor and provider. Dis Colon Rectum 2005;48:1016–20.

    Article  PubMed  Google Scholar 

  32. Noblett SE, Horgan AF. A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection. Surg Endosc 2007;21:404–8.

    Article  PubMed  CAS  Google Scholar 

  33. Bosio RM, Smith BM, Aybar PS, Senagore AJ. Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise. Am J Surg 2007;193:413–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio, 44106-5047, USA

    Conor P. Delaney M.D., Ph.D.

Authors
  1. Conor P. Delaney M.D., Ph.D.
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Corresponding author

Correspondence to Conor P. Delaney M.D., Ph.D..

Additional information

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.

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Delaney, C.P. Outcome of Discharge Within 24 to 72 Hours After Laparoscopic Colorectal Surgery. Dis Colon Rectum 51, 181–185 (2008). https://doi.org/10.1007/s10350-007-9126-y

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  • DOI: https://doi.org/10.1007/s10350-007-9126-y

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