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Richard Huettemann, Medical University of South Carolina, Charleston, SC

Background: Recent single institution reports have described the feasibility and safety of same day (POD0) discharge following laparoscopic colectomy in highly selected patients using erecovery after surgery (ERAS) protocols. We aim to identify the utilization of early discharge (postoperative day 0-2) after laparoscopic right colectomy using a national clinical database and assess the incremental impact of POD0 discharge on readmission among patients with early discharge.

Methods: We identified all patients undergoing elective laparoscopic right colectomy without concurrent additional procedures in the National Surgical Quality Improvement Project (NSQIP) from 2012 to 2017. Patients with early discharge (POD0-2) were compared to those discharged on postoperative day 3 or later (POD3+) with respect to demographics, operative details and postoperative course. Patients discharged POD0 were compared to those discharged POD1-2. The independent effect of POD0-2 discharge on the need for readmission was assessed using multivariable logistic regression. The independent effect of POD0 discharge on readmission was assessed among those discharged POD0-2.

Inclusion criteria were met by 19,798 patients with 114 (0.6%) discharged POD0, 427 (2.2%) POD1, and 3,423 (17.3%) POD2. The mean length of stay for the cohort was 4.4 days (SD: 3.7). Utilization of POD1 and POD2 discharge increased over the study period while POD0 discharges did not (Figure 1). Demographics and operative details are shown in table 1. Compared to patients discharged POD3+, patients discharged POD0-2 had decreased mortality (0.6 vs. 0.3%; p=0.04), decreased reoperation (3.2 vs. 0.8%; p<0.01) and decreased morbidity (16.1 vs. 5.8%; p<0.01) though no difference in readmission (7.2 vs. 6.5%; p=0.12). On regression, discharge POD0-2 was not associated with increased readmission (OR: 0.93; 95%CI: 0.80-1.09) as compared to patients discharged POD3+. Compared to patients discharged POD0-2, patients discharged POD0 had no difference in mortality (0.3 vs. 0%; p=1.0), reoperation (0.8 vs. 0.9%; p=0.60), morbidity (5.7 vs. 7.9%; p=0.31), post-discharge morbidity (5.3 vs. 3.2%; p=0.27) or readmission (6.5 vs. 6.1%; p=1.0). Among patients discharged POD0-2, POD0 discharge was not associated with readmission (OR: 1.01, 95%CI: 0.46-2.20).

Conclusions: While the utilization of early discharge (POD0-2) increased four-fold over the study period, POD0 discharge remains rare. However, POD0 discharge appears to be safe and is not associated with increased hospital readmission in this highly selected group. Patient and procedure differences were seen between those discharged POD0 as compared to POD1-2 suggesting that further work is required to define the patient population for whom POD0 discharge is appropriate.

Table 1: Demographics and operative details

Figure 1: Proportion of patients discharged on POD0, POD1, POD2 by year

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