Louise Gurowich
Adam Kimble, Louise Gurowich, Supriya Balasubramanya, Theresa Hinde, Jane Watson
Torbay Hospital, Torquay, United Kingdom
Abstract
Background
Enhanced recovery after surgery (ERAS) protocols have reduced length of stay in surgical patients, yet the pressures on NHS hospitals especially post-COVID-19, have driven the search for innovation that reduces inpatient bed usage further. Whilst the US demonstrates positive early outcomes, same-day discharges (SDD) in minimally-invasive colectomies have not yet been implemented and thoroughly evaluated in the UK.
Methods
We developed and present a 鈥淒ay Case Colorectal Resection鈥� pathway designed by colorectal surgeons and anaesthetists that focussed on patient selection and education, uncomplicated operation and optimal post-operative parameters that were considered safe for SDD. This was implemented for three patients undergoing minimally invasive colorectal resection. Patients were subject to close monitoring via virtual ward round after discharge, with a single in-person review on post-operative day 3.
Results
All three patients had elective laparoscopic sigmoid colectomy/high anterior resection for adenocarcinoma. Two of the three patients (66.6%) were successfully discharged on the same day of surgery. The first patient was admitted due to analgesic requirements and nausea; they were discharged on post-operative day 2. There were no reported adverse events, including no readmissions or ED attendances.
Conclusions
Same-day discharge colorectal resections are a safe and feasible option with strict patient selection criteria. The communication between surgeon and anaesthetist with optimised analgesia, close post-operative remote monitoring, appropriate expectation setting, and good social support ensures post-operative success, and patient experiences are positive. More work is required to assess the reproducibility of day-case colectomies across UK.