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Is Early Discharge Following Elective Surgery for Colon Cancer Safe? an Analysis of Short-Term Outcomes
Ahmad I. Elnahas*1,2, Timothy Jackson1,2, Allan Okrainec1,2, Fayez a. Quereshy1,2
1Surgery, University of Toronto, Toronto, ON, Canada; 2General Surgery, University Health Network, Toronto, ON, Canada
Introduction:
In the era of enhanced recovery programs, a better understanding of the safety and feasibility of early discharge following colon resection is needed. The objective of this study is to determine if "early discharge" (i.e. on postoperative day 1 or 2) following oncologic colon resections is comparable to "standard discharge" (i.e. on postoperative day 3 or 4) with respect to 30-day patient outcomes.
Methods and Procedures:
Data was obtained from the American College of Surgeons' National Surgery Quality Improvement Program participant use file to perform a retrospective cohort analysis. The study population consisted of patients discharged on postoperative day (POD) 1, 2, 3 or 4 that received an elective colon resection for a malignant neoplasm during 2011 and 2012. Patients were excluded if they had evidence of metastatic disease, a concurrent procedure or any recorded complication/death during their principal admission. The primary outcome was the proportion of 30-day adverse events, which was a composite endpoint of serious complications, mortality or reoperations. The secondary outcome was the proportion of 30-day readmissions. A multiple logistic regression analysis was performed to evaluate the primary and secondary outcomes based on the discharge category.
Results:
The sub-selected population consisted of 305 and 2277 patients in the early and standard discharge groups, respectively. Although an open approach was performed more often in the standard group (p=<0.001), there were no other major clinical differences between the two groups. The early group had 6 (1.97%) 30-day adverse events and the standard group had 59 (2.59%). There were 16 (5.56%) readmissions in the early group and 135 (6.24%) in the standard group. Using a multiple logistic regression analysis, an odds ratio (OR) estimate was adjusted for potential patient and operative confounders. No statistical difference was found between early and standard discharge with respect to the proportion of 30-day adverse events (OR 0.93, p=0.87, 95% CI [0.41-2.12]) and 30-day readmissions (OR 1.03, p=0.90, 95 % CI [0.61-1.76]). Male sex and open operations were significant predictors for adverse events, while longer operating time and open operations were significant predictors for readmissions.
Conclusion:
Using this large national surgical database, patients discharged on POD 1 or 2 after receiving elective oncologic colon resections did not have a significantly higher proportion of adverse events or readmissions compared to patients discharged on POD 3 or 4. Open surgery is a common predictor of adverse events and readmissions following colon resections with early discharge.
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