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Surgery

Same-Day Discharge After Minimally Invasive Colectomy

To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: September 28, 2022

Surgical Innovation

Article Information and Disclosures

Lawrence Lee, MD, PhD¹;

Elisabeth McLemore, MD²;

Laila Rashidi, MD³

Author Affiliations

¹McGill University Health Centre, Montreal, Quebec, Canada
²Kaiser Permanente, Los Angeles, California
³Multicare Health System, Tacoma, Washington

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Enhanced recovery pathways (ERP) for colorectal surgery have become standard of care for perioperative management but can be further improved.¹ Same-day discharge (SDD) programs represent the evolution of current ERP practices to allow for discharge on the day of surgery after minimally invasive surgery (MIS) colectomy. Pathways for SDD focus on minimizing or improving the aspects of care that keep a patient hospitalized, that is, (1) discharge before recovery of gastrointestinal function, (2) improvements in multimodal analgesia, and (3) effective postdischarge remote follow-up.² These elements act synergistically within a comprehensive program that is built on standard ERP practices to further minimize surgical stress and improve immediate postoperative recovery to the point of allowing for SDD in select patients undergoing MIS colectomy (Box).

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Article Information

Corresponding Author: Lawrence Lee, MD, PhD, McGill University Health Centre, 1001 Boulevard Decarie DS1-3310, Montreal, QC H4A 3J1, Canada (larry.lee@mcgill.ca).

Published Online: September 28, 2022. doi:10.1001/jamasurg.2022.4123

Conflict of Interest Disclosures: Dr Lee reported grants from Johnson & Johnson and personal fees from Stryker. Dr Rashidi reported personal fees from Intuitive Surgical. No other disclosures were reported.

References

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Lee L , Eustache J , Baldini G , et al. Enhanced recovery 2.0: same day discharge with mobile app follow-up after minimally invasive colorectal surgery. Ann Surg. Published online June 2, 2021. doi:10.1097/SLA.0000000000004962 PubMed Google Scholar Crossref

Surve A , Cottam D , Zaveri H , et al. Does the future of laparoscopic sleeve gastrectomy lie in the outpatient surgery center? a retrospective study of the safety of 3162 outpatient sleeve gastrectomies. Surg Obes Relat Dis. 2018;14(10):1442-1447. doi:10.1016/j.soard.2018.05.027 PubMed Google Scholar Crossref

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Lee L , Eustache J , Tran-McCaslin M , et al. North American multicentre evaluation of a same-day discharge protocol for minimally invasive colorectal surgery using mHealth or telephone remote post-discharge monitoring. Surg Endosc. 2022. doi:10.1007/s00464-022-09208-8 PubMed Google Scholar Crossref

Eustache J , Latimer EA , Liberman S , et al. A mobile phone app improves patient-physician communication and reduces emergency department visits after colorectal surgery. Dis Colon Rectum. Published online December 20, 2021. doi:10.1097/DCR.0000000000002187 PubMed Google Scholar Crossref

ESCP Enhanced Recovery Collaborating Group. An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019-2020. Colorectal Dis. 2021;23(11):2980-2987. doi:10.1111/codi.15863 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.