Introduction There is a lack of evidence guiding which discharge criteria to apply to patients following elective colorectal cancer resections. Many centres and authors advocate strict criteria which usually include a return of gastrointestinal function before discharge. However, this can lead to unnecessary delays in discharge which has particular relevance to a healthcare system strained by bed shortages. This study reports the experience of a single laparoscopic colorectal surgeon using simple discharge criteria on an enhanced recovery program to enable early discharge within 72 h.
Method A retrospective review of a single laparoscopic colorectal surgeon’s experience. Unselected consecutive patients from January 2010 to August 2014 were included. Patients were managed with an enhanced recovery program and simple discharge criteria were applied including stable vital signs, absence of vomiting, pain controlled on oral analgesia and tolerating a solid diet. Passing flatus or faeces was not used as a criteria for discharge.
Results 192 elective colorectal cancer resections were performed of which 168 were completed laparosocpically. The median length of stay was 3 days (range 1–72). 55% of patients were discharged within 72 h overall (laparoscopic 60%, open 17%). 27 patients were readmitted of which 10 had initially been discharged within 72 h. Among those readmitted who had initial hospital stays longer than 72 h, six required major abdominal re-operations whilst only one patient who had an initial stay under 72 h required abdominal surgery. The readmission rate for patients who were discharged within 72 h was 9% vs. 20% for patients with initial stays longer than 72 h (p = 0.02). In the final year of the study, 71% of patients were discharged within 72 h vs. 50% for the earlier years (p = 0.007).
Conclusion Early discharge within 72 h of elective colorectal cancer resections using simple criteria is safe and effective. Patients discharged early do not suffer worse outcomes than those with longer stays. There was a significant increase in the proportion of patients discharged within 72 h in the final year of the study reflecting increased awareness of the feasibility of this process. This could have significant benefits in a resource stretched healthcare system.
Disclosure of interest None Declared.