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Evolution from Enhanced Recovery to Same Day Colorectal Surgery

May 2024

Same Day Colorectal Surgery

The landscape of colorectal surgery has undergone significant transformation over the past decades, mainly due to advancements in surgical techniques and perioperative care protocols. This evolution has been particularly notable in the transition from traditional recovery protocols to Enhanced Recovery After Surgery (ERAS) protocols, and more recently, towards the implementation of Same-Day Discharge (SDD) in colorectal surgery. This article explores this progression, emphasizing data-driven outcomes that advocate for the feasibility and safety of SDD in colorectal procedures.

Same Day Colorectal Surgery
Same Day Colorectal Surgery

Enhanced Recovery After Surgery (ERAS)

ERAS protocols have been a cornerstone in the evolution of surgical care, significantly reducing the duration of hospital stays and improving outcomes for patients. The main principles of ERAS include minimizing preoperative fasting, optimizing pain control, reducing intravenous fluids, and encouraging early mobilization. These protocols have proven to decrease hospital stay lengths and improve recovery in elective abdominal colorectal surgeries.

Transition to Same-Day Discharge (SDD)

Building on the success of ERAS, the SDD concept represents a paradigm shift towards further minimizing hospital stays, even eliminating overnight hospitalization for selected patients undergoing minimally invasive colectomy. This approach aligns with goals to reduce healthcare costs, enhance patient satisfaction, and minimize the risk of nosocomial infections.

Data Supporting SDD in Colorectal Surgery

A retrospective analysis of a single-center experience underscores the safety and feasibility of SDD following minimally invasive colectomy. Over the period from April 2022 to April 2023, 86 non-emergent colectomies were analyzed. Of these, 41 patients (47.7%) were successfully discharged on the same day. Criteria for SDD included the patient's baseline health, social support, intraoperative findings, and immediate postoperative recovery. Notably, there were no readmissions among the SDD patients, highlighting the effectiveness of careful patient selection and thorough preoperative counseling.

Clinical and Operative Metrics

Key metrics from the study include:

  • Average Operation Time: 148.5 minutes
  • Average Intraoperative Fluids Used: 1500 mL
  • Estimated Blood Loss (EBL): 25 mL
  • Length of Stay (LOS): Average of 1 day for non-SDD patients, 0 days for SDD patients

These metrics reflect the meticulous execution of surgical and anesthetic techniques, optimized to facilitate a quick recovery and safe discharge.

Patient Selection and Preoperative Preparation

Crucial to the success of SDD is the rigorous selection of patients. Ideal candidates are those without significant comorbidities, who have strong social support and live within a reasonable distance from the hospital. Preoperative education is critical, ensuring that patients and their families are fully informed about expectations and post-discharge self-care requirements.

Challenges and Considerations

While SDD offers numerous benefits, it also presents challenges such as the need for precise patient selection and the potential for increased post-discharge complications if not properly managed. Surgeons must be adept at identifying suitable candidates and ensuring robust follow-up. Additionally, infrastructure for remote monitoring and support must be established to effectively manage any complications outside the hospital setting.

Conclusion

The evolution from ERAS to SDD in colorectal surgery is a testament to ongoing advancements in surgical care. This transition not only improves outcomes for patients but also aligns with broader goals of efficiency and cost-effectiveness in healthcare. As data continues to support the safety and feasibility of SDD, more centers are expected to adopt this approach, further refining protocols to include a wider range of patients and procedures.

The journey from enhanced recovery to same-day surgery is not just about shortening hospital stays but also about transforming the patient experience and optimizing healthcare system resources. Future research and collaborative efforts will be crucial to overcoming challenges and maximizing the potential of SDD in colorectal surgery.

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