For a study, researchers sought to determine the viability and safety of ambulatory surgery. All patients undergoing colorectal resection/anastomosis between October 2020 and October 2021 who met the preoperative recommendations for ambulatory surgery (discharge within 24 hours of surgery) included those with no major comorbidities and were not taking therapeutic anticoagulation and were compliant patients and families. Universal inpatient admission following colorectal resection was preferred by current clinical doctrine, especially when an anastomosis is present. Exclusion criteria included ostomy construction (loop/end ileostomy, Hartmann’s, abdominoperineal resection), complicated surgery (ileoanal pouch, enterocutaneous fistula repair, reoperative pelvic surgery), and/or complicated surgery (ileoanal pouch, enterocutaneous fistula, multiple resections). If all predetermined conditions (no ostomy teaching required, comfortable ambulation, tolerating diet, stable vitals, and stable blood work) were met and patients were willing, discharge was 6 to 8 hours after surgery. If patients requested a postponement to the following day, discharge was delayed until that day. With the option of voluntary readmission, if the patient desired inpatient care, all discharged patients received phone checks the next day. Patients who were released within 24 hours of surgery (AmbC) were compared to those who remained as inpatients (InpC) and to a similar historical cohort (October 2019–October 2020) during which ambulatory surgery was not available (HistC). About 97 individuals underwent difficult colorectal resection and/or ostomy out of 184 who underwent abdominal colorectal surgery. About 29 (33.3%) of the 87 remaining patients were released within 24 hours of surgery [7 (24%) patients at 8 h]. Of these 29 AmbC patients, 4 (ileus, rectal bleeding, nausea/vomiting), 1 (readmission on the first post-discharge day), and none (voluntary post-phone-check) were readmitted within 30 days. Age, sex, race, body mass index, and comorbidity were comparable between AmbC and InpC (n=58). While the estimated blood loss was higher in InpC (109 vs. 34 mL, P<0.001), the expectedly longer length of stay (109 vs. 17 hours, P<0.001) was also significantly higher. In neither group was there any mortality. Anastomotic leak, reoperation, readmission, ileus, and surgical site infection were all similar across AmbC and InpC. For HistC, the average length of stay was 83 hours. AmbC and HistC were comparable in terms of age, sex, race, BMI, and ASA class. For AmbC and HistC, complications such as readmission, reoperation, anastomotic leak, ileus, and surgical site infection were comparable. It was possible to perform ambulatory surgery in up to one-third of patients undergoing colorectal resection/anastomosis, similar to the traditional procedure of routine inpatient hospitalization with careful patient selection, preoperative education, perioperative management, and postoperative follow-up. A paradigm shift in managing such patients will be made possible by improving the inclusion/exclusion criteria and postoperative outpatient follow-up. This will have a significant impact on the patient experience, the workload of caregivers, and the cost of healthcare.
