Abstract
Introduction The introduction of Enhanced Recovery After Surgery led to increasing twenty-four
hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric
surgery. However, implementation in colorectal surgery still must set off. This systematic
review assesses safety and feasibility of twenty-four hours discharge in colorectal
surgery in terms of readmission and complications in current literature. Secondary
outcome was identification of factors associated with success of twenty-four hours
discharge.
Methods Pubmed and EMBASE databases were searched to identify studies investigating twenty-four
hours discharge in colorectal surgery, without restriction of study type. Search strategy
included keywords relating to ambulatory management and colorectal surgery. Studies
were scored according to MINORS score.
Results Thirteen studies were included in this systematic review, consisting of six prospective
and seven retrospective studies. Number of participants of the included prospective
studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four
hours discharge group. All prospective studies showed similar readmission and complication
rates between twenty-four hours discharge and conventional postoperative management.
Factors associated with success of twenty-four hours discharge were low ASA classification,
younger age, minimally invasive approach, and relatively shorter operation time.
Conclusions Twenty-four hours discharge in colorectal surgery seems feasible and safe, based
on retro- and prospective studies. Careful selection of patients and establishment
of a clear and adequate protocol are key items to assure safety and feasibility. Results
should be interpreted with caution, due to heterogeneity. To confirm results, an adequately
powered prospective randomized study is needed.
Keywords
ERAS - ambulatory - 24 hours discharge - twenty-four hours stay - hospitalization
- colorectal
