EP867 - Same Day Discharge after Minimally Invasive Colorectal Surgery: A Matched Case-Control Study

ePoster Presenter(s)

• 

  Delaney Taylor, MD (she/her/hers)

  Resident
  Icahn School of Medicine at Mount Sinai
  Icahn School of Medicine at Mount Sinai
  New York, NY, United States

  Disclosure information not submitted.

Author(s)

• 

  Rossana Cheng He, MD (she/her/hers)

  Resident
  Mount Sinai Hospital
  New York, NY, United States

  Disclosure information not submitted.

Author(s)

• SC

  Sarah Cao, MD

  Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• KD

  Katherine F. Donovan, MD

  Resident
  New York Medical College at Metropolitan Hospital
  New York, New York, United States

  Disclosure information not submitted.
• CP

  Clark Pitcher, MD

  Resident
  Mount Sinai Hospital
  Mount Sinai Hospital
  New York, NY, United States

  Disclosure information not submitted.
• EA

  Eziwoma O. Alibo, MD, PHD

  Resident Physician
  Icahn School of Medicine at The Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• GY

  George Youssef, MD

  Resident
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• RL

  Rashid Logan, MD

  Surgical Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• LC

  Laura C. Caplan, PA-C

  Senior Physician Associate
  The Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• MM

  Maria M. Meyer, n/a

  Medical Student
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• RS

  Randolph M. Steinhagen, n/a

  Professor of Surgery
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• SH

  Sue J. Hahn, MD

  Assistant Professor of Surgery
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• TL

  Tianyi Lu, MD

  Assistant Professor
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• 

  Alex J. Ky, MD (she/her/hers)

  Professor of Surgery
  Mount Sinai Hospital
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• ER

  Emily Rinebold, MD

  Assistant Professor
  Elmhurst Hospital Center
  New York, New York, United States

  Disclosure information not submitted.
• EF

  Erica Fagelman, MD

  Assistant Professor of Anesthesiology
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• DB

  Deepika Bhasin, MD, MPH

  Associate Director, Surgical Quality
  Mount Sinai Health System
  New York, New York, United States

  Disclosure information not submitted.
• CS

  Christine R. Scott, MSN RN

  Senior Director PACU
  Mount Sinai Hospital
  North Haledon, New Jersey, United States

  Disclosure information not submitted.
• JT

  Janet Thompson, BSN, RN

  Clinical Nurse Manager
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Patricia Sylla, MD, FACS, FASCRS (she/her/hers)

  System Chief of Colon and Rectal Surgery
  Mount Sinai Hospital
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: Minimally invasive surgery (MIS) and enhanced recovery protocols have substantially reduced hospital length of stay (LOS) after colorectal surgery. The feasibility and safety of Same Day Discharge (SDD; discharge on postoperative day [POD] 0 or 1) protocols have been previously demonstrated in selected patients. In order to address institutional chronic bed shortages, a multidisciplinary SDD protocol with discharge by POD 1 was implemented in patients undergoing elective MIS colorectal resections. Retrospective analysis was conducted to review SDD outcomes relative to that of a matched cohort of patients discharged as per standard of care (SOC).

Methods/Interventions: An institutional SDD protocol was implemented as a quality initiative in January 2022 as a collaboration among surgery, anesthesia, and perioperative nursing champions (Table 1). Eligible patients scheduled for elective MIS colorectal resection were prospectively enrolled in the SDD protocol. Successful discharge by POD 1 was recorded and 30-day outcomes were retrospectively compared to that of a matched institutional National Surgical Quality Improvement Project (NSQIP) cohort of SOC patients over the same study period. Outcomes included LOS, postoperative opioid use, time to return of bowel function, and 30-day readmission, complications and reoperation rates. Coarsened exact matching was performed based on age, sex, body mass index (BMI), ASA classification, and procedure type. Firth's penalized logistic regression was used to assess 30-day readmission, and continuous and categorical variables were analyzed with the Mann-Whitney U and Fisher's exact tests, respectively.

Results/Outcomes: Between January 2022 and July 2025, 66 patients undergoing elective laparoscopic or robotic partial colectomy or ostomy reversal were enrolled in the SDD protocol. Successful discharge by POD 1 was achieved in 64 (97%) patients. Among these, the median LOS was 0.9 days (IQR 0.4-1.0) with a 30-day readmission rate of 7.8%. Of 547 patients reviewed (64 SDD, 483 SOC), 56 SDD patients were successfully matched to 149 SOC patients. After matching, median LOS was significantly shorter in the SDD group compared with SOC (0.9 [IQR 0.3-1.0] vs. 4.0 [IQR 2.8-5.0] days; p < 0.001). At 30 days, readmission rates were 7.1% vs. 3.4% (odds ratio [OR] 2.09, 95% CI 0.33-12.3; p = 0.41), major complication rates (Clavien-Dindo ≥ III) were 10.7% vs. 5.4% (OR 2.11; p = 0.21), and reoperation rates were 3.6% vs. 2.7% (OR 1.34; p = 0.67) in the SDD and SOC groups, respectively (Table 2). SDD patients had lower opioid use (median 3 vs. 5 morphine milligram equivalents/day, p < 0.001) and faster bowel recovery (flatus: 1.0 [IQR 1.0-1.5] vs. 2.0 [IQR 2.0-3.0] days; bowel movement: 2.0 [IQR 1.0-2.0] vs. 3.0 [IQR 2.0-4.0] days; both p < 0.001).

Conclusion/Discussion: In this matched case-control study conducted at a tertiary medical center, implementation of a SDD protocol in carefully selected patients undergoing elective MIS colorectal surgery, was not associated with significant increased rates of readmissions or complications. Patients managed under the SDD pathway required fewer opioids and achieved faster bowel recovery, providing a foundation for future prospective validation and cost-effectiveness studies.

Table 1. Key Elements of Same Day Discharge Protocol
Table 2. Patient Characteristics and 30-Day Clinical Outcomes of the Pre- and Post-Match Cohorts