Safety of hospital discharge before return of bowel function after elective colorectal surgery
EuroSurg Collaborative, Stephen J. Chapman, R Blanco-Colino, S Pérez-Ajates, O Anabitarte Bautista, James Hodson, R Blanco-Colino, Stephen J. Chapman, James Glasbey, Francesco Pata, Gianluca Pellino, AS Soares, T van Elst, Stephanie Van Straten, Dmitri Nepogodiev, James Hodson, Aditya Borakati, M F Bath, Ifat Yasin, Kenneth A McLean, Thomas Arthur, M Kovacević, S Delibegovic, M Karamanliev, Mohamed Swamad, R Žebrák, R Paramasivam, Anne Kraushaar Martensen, Helene Mathilde Larsen, Lukas Rädeker, Pia‐Elena Frey, A Kechagias, Aurélien Venara, E Duchalais, Argyrios Ioannidis, Francesco Pata, G Pellino, Sandro Pasquali, Andrea Simioni, Valeria Farina, M Podda, Laura Lorenzon, ItSURG, V Schaeff, Amy D. Otto, Matas Jakubauskas, T R van Elst, Michael Jen Jie Chu, Paul Fagan, Cameron I. Wells, A Alagoa João, António Sampaio Soares, Jovan Juloski, R Blanco-Colino, S Pérez-Ajates, O Anabitarte Bautista, Y El Kasmy El Kasmi, Eloy Espín, D Clerc, Cezar Ciubotaru, S S Popescu, A Yanishev, S Lee, Bahar Büşra Özkan, A Yagız Sen, M K Aktas, Bahadır Emre Baki, B Yüksek, James Glasbey, Sivesh K. Kamarajah, Kenneth A McLean, Aditya Borakati, Ifat Yasin, Rachel A Khaw, Emily Mills, Ross Goodson, Nimish Thakral, Andrew D. Ablett, M Adra, I Kwek, S Khan, P Quinn, L R Manley, Abdul Badran, A Ramjeeawon, A Campbell, Haiyan Tan, Dupinderjit Rye, Nikitha Rajaraman, James G. Norman, Kritchai Vutipongsatorn, Georgios Solomou, Melika Akhbari, Ased Ali, B D Brandao, B Stainer, Rachel Thavayogan, Daniel Jones, Oluwatobi Onafowokan, A Gharooni
Abstract
BACKGROUND: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. METHODS: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. RESULTS: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). CONCLUSION: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.