Safety of hospital discharge before return of bowel function after elective colorectal surgery

EuroSurg Collaborative (2020) Safety of hospital discharge before return of bowel function after elective colorectal surgery. British Journal of Surgery, 107 (5). pp. 552-559. ISSN 0007-1323

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Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.

Item Type: Article
Additional Information: Funding Information: The authors are grateful to the European Society of Coloproctology (ESCP) Executive for providing facilities to host collaborator meetings in Berlin (September 2017) and Nice (September 2018); the ESCP Cohort Studies and Audits Committee for their review of the study protocol; and to the Dukes Club (UK), Portuguese Surgical Research Collaborative (Portugal), Young Group of the Italian Society of Colorectal Surgery, Italian Surgical Research Group (Italy), Australasian Students' Surgical Association, and Clinical Trials Network of Australia and New Zealand (Australia and New Zealand) for assistance with study dissemination. They thank the Birmingham Surgical Trials Consortium at the University of Birmingham (UK) for support with online data capture and the Yorkshire Surgical Research Collaborative (UK) for access to unpublished data. Disclosure: The authors declare no conflict of interest. Publisher Copyright: © 2020 BJS Society Ltd Published by John Wiley & Sons Ltd
Uncontrolled Keywords: medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 07 Sep 2022 09:30
Last Modified: 03 Nov 2022 16:37
DOI: 10.1002/bjs.11422

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