Karleigh R Curfman1, Ashwini S Poola2, Gabrielle E Blair3, Callan L Kosnik4, Sunshine A Pille5, Evan L Thilo6, Melinda E Hawkins7, Laila Rashidi8. 1. MultiCare Health Network, Tacoma, WA, 98405, USA. Electronic address: karleigh.curfman@multicare.org. 2. MultiCare Health Network, Tacoma, WA, 98405, USA. Electronic address: ashwini.poola@multicare.org. 3. University of Portland, Portland, OR, 97203, USA. Electronic address: blair24@up.edu. 4. MultiCare Health Network, Tacoma, WA, 98405, USA. Electronic address: callan.kosnik@multicare.org. 5. MultiCare Health Network, Tacoma, WA, 98405, USA. Electronic address: pillesu@multicare.org. 6. MultiCare Health Network, Tacoma, WA, 98405, USA. Electronic address: elthilo@multicare.org. 7. Swedish Medical Center, Seattle, WA, 98104, USA. Electronic address: melinda.hawkins@swedish.org. 8. MultiCare Health Network, Tacoma, WA, 98405, USA. Electronic address: laila.rashidi@multicare.org.
Abstract
BACKGROUND: Since its inception colectomy has routinely been performed in the inpatient setting. The advent of Enhanced Recovery After Surgery (ERAS) protocols has led improved outcomes, including decreased length of stay (LOS). These improvements have introduced the possibility of ambulatory colectomy. However, indications, protocols, and limitations of ambulatory colectomy have not been extensively explored. METHODS: We conducted a retrospective review on ambulatory colectomies performed between February 2019 and August 2021. Patients were candidates for same day discharge (SDD) if they met rigorous preoperative criteria. Following an uncomplicated operation, strict postoperative parameters were required for safe discharge. If the patient underwent SDD following their operation, they were monitored closely via telehealth visits and/or patient communication messages until their one-week postoperative visit. RESULTS: From our review, we identified sixty-nine (n = 69) patients who underwent SDD after colectomy. Of the 69, only one patient was readmitted after discharge (1.4%). All procedures were performed via a robotic-assisted approach (Da Vinci Xi). None of the patients underwent conversion to an open procedure. The most frequently performed procedures included: low anterior resection (LAR) (n = 32, 46.4%) and right hemicolectomy (n = 11, 15.9%). CONCLUSION: Through proper patient education and strictly defined communication between the patient care teams, safe and effective care in the setting of SDD after colectomy can be provided. With recent technological advancements, enhanced mechanisms for patient education throughout all phases, and emerging means of patient-physician communication, via the data included herein the opportunity for same day discharge (SDD) after colectomy is a feasible and safe management plan in the proper patient.
BACKGROUND: Since its inception colectomy has routinely been performed in the inpatient setting. The advent of Enhanced Recovery After Surgery (ERAS) protocols has led improved outcomes, including decreased length of stay (LOS). These improvements have introduced the possibility of ambulatory colectomy. However, indications, protocols, and limitations of ambulatory colectomy have not been extensively explored. METHODS: We conducted a retrospective review on ambulatory colectomies performed between February 2019 and August 2021. Patients were candidates for same day discharge (SDD) if they met rigorous preoperative criteria. Following an uncomplicated operation, strict postoperative parameters were required for safe discharge. If the patient underwent SDD following their operation, they were monitored closely via telehealth visits and/or patient communication messages until their one-week postoperative visit. RESULTS: From our review, we identified sixty-nine (n = 69) patients who underwent SDD after colectomy. Of the 69, only one patient was readmitted after discharge (1.4%). All procedures were performed via a robotic-assisted approach (Da Vinci Xi). None of the patients underwent conversion to an open procedure. The most frequently performed procedures included: low anterior resection (LAR) (n = 32, 46.4%) and right hemicolectomy (n = 11, 15.9%). CONCLUSION: Through proper patient education and strictly defined communication between the patient care teams, safe and effective care in the setting of SDD after colectomy can be provided. With recent technological advancements, enhanced mechanisms for patient education throughout all phases, and emerging means of patient-physician communication, via the data included herein the opportunity for same day discharge (SDD) after colectomy is a feasible and safe management plan in the proper patient.
Authors: Elisabeth C McLemore; Lawrence Lee; Traci L Hedrick; Laila Rashidi; Erik P Askenasy; Daniel Popowich; Patricia Sylla Journal: Surg Endosc Date: 2022-09-21 Impact factor: 3.453