Same day discharge following elective, minimally invasive, colorectal surgery,Surgical Endoscopy

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Same day discharge following elective, minimally invasive, colorectal surgery
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-09-21 , DOI: 10.1007/s00464-022-09606-y
Elisabeth C McLemore _{1,

2} , Lawrence Lee ₃ , Traci L Hedrick ₄ , Laila Rashidi ₅ , Erik P Askenasy ₆ , Daniel Popowich ₇ , Patricia Sylla ₈

Affiliation

Background

As enhanced recovery programs (ERPs) have continued to evolve, the length of hospitalization (LOS) following elective minimally invasive colorectal surgery has continued to decline. Further refinements in multimodal perioperative pain management strategies have resulted in reduced opioid consumption. The interest in ambulatory colectomy has dramatically accelerated during the COVID-19 pandemic. Severe restrictions in hospital capacity and fear of COVID transmission forced surgical teams to rethink strategies to further reduce length of inpatient stay.

Methods

Members of the SAGES Colorectal Surgery Committee began reviewing the emergence of SDD protocols and early publications for SDD in 2019. The authors met at regular intervals during 2020–2022 period reviewing SDD protocols, safe patient selection criteria, surrogates for postoperative monitoring, and early outcomes.

Results

Early experience with SDD protocols for elective, minimally invasive colorectal surgery suggests that SDD is feasible and safe in well-selected patients and procedures. SDD protocols are associated with reduced opioid use and prescribing. Patient perception and experience with SDD is favourable. For early adopters, SDD has been the natural evolution of well-developed ERPs. Like all ERPs, SDD begins in the office setting, identifying the correct patient and procedure, aligning goals and objectives, and the perioperative education of the patient and their supporting significant others. A thorough discussion with the patient regarding expected activity levels, oral intake, and pain control post operatively lays the foundation for a successful application of SDD programs. These observations may not apply to all patient populations, institutions, practice types, or within the scope of an existing ERP. However, if the underlying principles of SDD can be incorporated into an existing institutional ERP, it may further reduce the incidence of post operative ileus, prolonged LOS, and improve the effectiveness of oral analgesia for postoperative pain management and reduced opioid use and prescribing.

Conclusions

The SAGES Colorectal Surgery Committee has performed a comprehensive review of the early experience with SDD. This manuscript summarizes SDD early results and considerations for safe and stepwise implementation of SDD with a specific focus on ERP evolution, patient selection, remote monitoring, and other relevant considerations based on hospital settings and surgical practices.

中文翻译：

择期微创结直肠手术后当天出院

背景

随着加速康复计划（ERP）的不断发展，择期微创结直肠手术后的住院时间（LOS）持续下降。多模式围手术期疼痛管理策略的进一步完善减少了阿片类药物的消耗。在 COVID-19 大流行期间，人们对门诊结肠切除术的兴趣急剧增加。医院容量的严格限制以及对新冠病毒传播的恐惧迫使手术团队重新考虑进一步缩短住院时间的策略。

方法

SAGES 结直肠手术委员会成员于 2019 年开始审查 SDD 方案的出现和 SDD 的早期出版物。作者在 2020 年至 2022 年期间定期会面，审查 SDD 方案、安全患者选择标准、术后监测替代方案和早期结果。

结果

用于择期微创结直肠手术的 SDD 方案的早期经验表明，SDD 对于精心挑选的患者和手术来说是可行且安全的。SDD 方案与减少阿片类药物的使用和处方有关。患者对 SDD 的认知和体验是良好的。对于早期采用者来说，SDD 是成熟 ERP 的自然演变。与所有 ERP 一样，SDD 从办公室环境开始，确定正确的患者和手术，调整目的和目标，以及患者及其支持的重要其他人的围手术期教育。与患者就预期活动水平、口腔摄入量和术后疼痛控制进行彻底讨论，为 SDD 计划的成功应用奠定基础。这些观察结果可能不适用于所有患者群体、机构、实践类型或现有 ERP 范围内。然而，如果 SDD 的基本原则能够纳入现有的机构 ERP 中，则可能会进一步降低术后肠梗阻、延长 LOS 的发生率，并提高口腔镇痛用于术后疼痛管理的有效性，并减少阿片类药物的使用和处方。