Hospital discharge before return of bowel function after colorectal surgery safe for some

Last Updated: 2020-02-06

By Will Boggs MD

NEW YORK (Reuters Health) - For carefully selected patients, hospital discharge before return of bowel function after elective colorectal surgery is safe, according to findings from the EuroSurg Collaborative.

"In this study, even though discharge before the return of bowel function seemed to be safe, it was surprising to see this practiced so infrequently," Dr. Stephen J. Chapman of St. James's University Hospital, University of Leeds, in the UK, told Reuters Health by email. "It suggests that more research is needed to explore the barriers to early discharge, if indeed this is confirmed to be appropriate."

Passage of flatus, but not necessarily of stool, has been determined to be an essential criterion for discharge from hospital after colorectal surgery, but the traditional practice of prolonging discharge until full return of bowel function persists.

Dr. Chapman and colleagues explored the safety of discharge before return of bowel function, with a focus on hospital readmission, in their planned additional analysis of the international IMAGINE study, which explored the safety and efficacy of nonsteroidal anti-inflammatory drugs for reducing ileus after colorectal surgery.

For the purposes of this analysis, return of bowel function was defined as the time taken for patients to tolerate solid food and to pass stool.

Among the 3,288 patients included in the study, 301 (9.2%) were discharged before return of bowel function, the researchers report in BJS.

Patients discharged before return of bowel function had a median hospital stay of five days, compared to seven days for those discharged after return of bowel function.

Patients discharged before return of bowel function were significantly more likely to have undergone minimally invasive surgery, more likely to have had a right colonic resection, and less likely to have had a new stoma formed, compared with patients discharged after return of bowel function.

The rates of readmission within 30 days of surgery did not differ significantly between patients discharged before (6.6%) and after (8.0%) achieving return of bowel function, regardless of the postoperative day of discharge.

The two groups did not differ in the rates of minor or major complications, anastomotic leak, intra-abdominal collection, pneumonia, or acute kidney injury, either.

"A number of factors may contribute to the decision-making around hospital discharge," Dr. Chapman said. "It is a complex and multidisciplinary process. It is unlikely that our study accounts for all of these, but it provides a foundation to build upon further."

"It is important to emphasize that this study has limitations, and that more work in this area is needed," he said. "It is hoped that physicians and academics will explore the issue further, particularly with respect to patients' views and opinions on the timing of discharge."

SOURCE: https://bit.ly/39gNog7 BJS, online January 24, 2020.