Abstract
Background
Enhanced recovery after surgery programs have improved patient outcomes following
colorectal surgery. This has provided a platform for the consideration of ambulatory
colectomies where patients are discharged within 24 hours after surgery. Although
some studies have demonstrated its feasibility, the safety profile and patient eligibility
criteria for discharge within 24 hours after surgery remain relatively ill-defined.
This study provided a review of the patient selection criteria and postoperative outcomes
shown in patients discharged within 24 hours after surgery.
Methods
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping
Reviews guidelines were adhered to. A comprehensive search was performed on 3 electronic
databases, and the relevant articles were identified. The primary outcome measures
were postoperative morbidity and readmission rates. The different domains relevant
to the selection of patients and perioperative care of patients discharged within
24 hours after surgery were also qualitatively assessed.
Results
Eight studies were included, which involved a total of 1,229 patients. The majority
of selected patients underwent elective laparoscopic colonic surgeries. The patient
characteristics, such as age, comorbidities, obesity, and psychosocial environment,
were important considerations. A close follow-up with home-based medical services
was ideal in patients discharged within 24 hours after surgery. The readmission rates
ranged from 0.0% to 9.0%. Despite morbidity rates of up to 26.7%, the majority of
them were minor and classified as Clavien-Dindo Grade I to II.
Conclusion
The use of programs related to discharge within 24 hours after surgery in colorectal
surgery is safe, feasible, and practical in a select group of patients within a well-designed
clinical framework and pathway. Future studies should compare patient outcomes following
discharge within 24 hours after surgery with conventional enhanced recovery after
surgery protocols. In addition, patient and caregiver perceptions, quality of life,
and cost-effectiveness analysis should also be performed.
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Article info
Publication history
Published online: July 12, 2022
Accepted:
April 29,
2022
Footnotes
Jarrod K.H. Tan was responsible for conceptualization, methodology, and writing (original draft preparation, review, and editing). Lina Choe and Jerrald Lau were responsible for conceptualization, methodology, and writing (review and editing). Ker-Kan Tan was responsible for conceptualization and writing (review and editing).
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
