A. I. Elnahas1, F. Quereshy1, R. Kelly2, T. Jackson1, A. Okrainec1, S. Chadi1, E. Le Souder1, U. David3 1Toronto Western Hospital,General Surgery,Toronto, ONTARIO, Canada 2University of Toronto,Surgery,Toronto, ONTARIO, Canada 3Women’s College Hospital,General Surgery,Toronto, ONTARIO, Canada
Introduction: The recent expansion of enhanced recovery programs after surgery has safely permitted early discharge for select patients following routine operations. As a result, more procedures are now being considered appropriate for outpatient surgery. The objective of this study is to determine if early discharge (i.e. less than 24 hours) following ileostomy closure is comparable to standard discharge (i.e. discharge on postoperative day 2 or 3) with respect to 30-day clinical outcomes.
Methods: 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) 0, 1, 2, or 3 who underwent elective ileostomy closure from 2005-2014. Patients were excluded if they had any concurrent procedure(s) or documented complications during admission. The primary outcome was the 30-day adverse event rate and the secondary outcome was the 30-day readmission rate. A multiple logistic regression analysis was performed to determine the adjusted effect of early discharge as well as the predictors of adverse events and readmissions.
Results: The study population consisted of 355 and 5798 patients in the early and standard discharge groups, respectively. There were no relevant clinical differences between the two groups. There were 19 (5.4%) 30-day adverse events in the early group and 341 (5.8%) in the standard group. The early group had 17 (4.8%) 30-day readmissions and the standard group had 294 (5.1%). Using a multiple logistic regression, an adjusted odds ratio (OR) estimate for 30-day adverse events and readmissions was determined for early discharge. The adjusted OR for 30-day adverse events was 0.95 (p=0.83) and for 30-day readmissions was 1.01 (p=0.96). Higher body mass index, longer operative time, ASA≥3, chronic steroid use along with a history of bleeding disorder and diabetes were significant predictors for adverse events and readmissions.
Conclusion: Using this large national surgical database, select patients discharged within 24 hours of ileostomy closure did not have a significantly higher rate of adverse events or readmissions compared to patients discharged on POD 2 or 3 following uncomplicated surgery. Predictors of adverse events and readmissions can help guide the selection of patients suitable for early discharge.