Predicting Who Will Fail Early Discharge After Laparoscopic Colorectal Surgery with an Established Recovery Pathway

Deborah S Keller, MD, Blake Bankwitz, MS, Justin K Lawrence, MD, Brad J Champagne, MD, FACS, Harry L Reynolds, Jr., MD, Sharon L Stein, MD, FACS, Conor P Delaney, MD, MCh, PhD

University Hospitals-Case Medical Center

Purpose: Despite using laparoscopy and enhanced recovery protocols (ERP), some patients are not ready for early discharge. The goal of this study was to identify predictors for patients who might fail early discharge, so that any defined factors might be addressed and optimized.

Methods: A review of a prospectively maintained database identified all major elective laparoscopic colorectal surgical procedures between 2009-2012. Patients were divided into Day of Discharge groups: ≤3 days and > 3 days. All followed a standardized ERP. Demographic and clinical data was compared using students paired t-tests or Fisher’s Exact test, with p-value < 0.05 statistically significant. Regression analysis was performed to identify significant variables.

Results: There were 275 ≤3 days patients and 273 > 3 day patients. There were significant differences between groups in BMI (p=0.0123), co-morbidities (p=0.0062), ASA Class (p=0.0014), operation time (p<0.001), post-operative complications (p< 0.001), and 30-day re-operation rate (p=0.0004). There were no significant differences in intra-operative complications (p=0.724), readmissions (p=0.187), or mortality rate (p = 1.00). Significantly more patients were discharged directly home in the ≤3 days cohort. Using logistic regression, every hour of operating time increased the risk of length of stay >3 days by 2.35%.

Conclusions: Elective colorectal surgery patients with longer operation times and more co-morbidities are more likely to fail early discharge. These patients should have different expectations of the ERP, as an expected 2-3 day stay may not be achievable. By identifying patients at risk for failing early discharge, resources and post-operative support can be better allocated.

Session: Podium Presentation

Program Number: S074

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