EP620 - Early Discharge and Readmission for Robotic Left Sided Colectomies

Image or Table (Do Not add text here):

Purpose/Background: There have been small studies done to evaluate the efficacy of early discharge for patients who undergo robotic colorectal surgery. However, there has never been a large study over multiple years done to evaluate the safety of early discharge for patients who have undergone robotic left sided colon surgery. In our study, we compare the 30 day readmission rate and other postoperative complications of patients who underwent robotic left sided colon resections, including left colectomy, sigmoidectomy, and low anterior resection, that were either discharged early, hospital stay of 0 or 1 day, versus those who underwent the standard discharge of 2 or more days.

Methods/Interventions: We studied patients who underwent robotic left sided colon resection between 2014 and 2023 at a single HMO hospital system. The robotic surgeries that were evaluated included sigmoidectomy, left colectomy, or low anterior resection for one of the following medical conditions: diverticulitis, colon cancer, rectal cancer, ulcerative colitis, or malignant polyp. After exclusion, a total of 801 patients were included and separated into an early discharge group (length of stay of 0 or 1 day), or standard discharge group (length of stay of 2 or more days). Postoperative complications were evaluated between the two groups including 30 day readmission, ileus, small bowel obstruction, urinary tract infection, acute kidney injury, pulmonary embolism, surgical site infection, and re-operation.

Results/Outcomes: Overall, the early discharge group had 241 patients while the standard discharge group had 560 patients. Within the early discharge group, 17 of 241 (7.1%) were readmitted within 30 days of surgery and 63 of 560 (11.3%) within the standard discharge group were readmitted within 30 days of surgery (p=0.07). The standard discharge group had higher percentages for all postoperative complications, although all were statistically insignificant except for postoperative pulmonary embolism (PE). None of the early discharge patients had postoperative PE, but 11 of 560 (2%) in the standard discharge group had a postoperative PE (p=0.03).

Conclusion/Discussion: Standard discharge patients were more likely to develop a postoperative PE compared to early discharge; otherwise there was no significant difference in outcomes between the two groups. This may be due to early mobilization required of patients who discharge home earlier compared to patients who stay in the hospital longer. For hospitalized patients, it is much easier to stay in bed with activities of daily living being done for them by hospital staff. Early mobilization is an important component to post surgical care and our study concludes that early discharge is non-inferior in terms of readmission rates to the standard discharge. The cost of one inpatient hospital day is estimated at $4337 in California, which can add a significant burden to the health care system. This study suggests that early discharges, when done safely, can help reduce the burden of cost on unnecessary hospital stays, as well as decrease the likelihood of developing a postoperative pulmonary embolism by encouraging early mobilization.