North American multicentre evaluation of a same-day discharge protocol for minimally invasive colorectal surgery using mHealth or telephone remote post-discharge monitoring

Lawrence Lee; Jules Eustache; Marie Tran-McCaslin; Motahar Basam; Gabriele Baldini; Andrew G Rudikoff; Sender Liberman; Liane S Feldman; Elisabeth C McLemore

doi:10.1007/s00464-022-09208-8

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 Dec;36(12):9335-9344. doi: 10.1007/s00464-022-09208-8. Epub 2022 Apr 13.

Authors

Lawrence Lee¹, Jules Eustache², Marie Tran-McCaslin³, Motahar Basam³, Gabriele Baldini⁴, Andrew G Rudikoff⁵, Sender Liberman², Liane S Feldman², Elisabeth C McLemore³

Affiliations

¹ Department of Surgery, McGill University Health Centre, 1001 Boul. Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada. larry.lee@mcgill.ca.
² Department of Surgery, McGill University Health Centre, 1001 Boul. Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada.
³ Department of Surgery, Kaiser Permanente LA Medical Center, Los Angeles, CA, USA.
⁴ Department of Anaesthesia, McGill University Health Centre, Montreal, QC, Canada.
⁵ Department of Anaesthesia, Kaiser Permanente LA Medical Center, Los Angeles, CA, USA.

PMID: 35419638
DOI: 10.1007/s00464-022-09208-8

Abstract

Background: Same-day discharge (SDD) after colectomy is feasible but requires effective post-discharge remote follow-up. Previous studies have used in-person home visits or a mobile health (mHealth) phone app, but the use of simple telephone calls for remote follow-up has not yet been studied. Therefore, the objective of this study was to compare outcomes after SDD for minimally invasive colectomy using mHealth or telephone remote post-discharge follow-up.

Methods: A prospective cohort study was undertaken at two university-affiliated colorectal referral institutions from 02/2020 to 05/2021. Adult patients without significant comorbidities undergoing elective minimally invasive colectomy. Patients were discharged on the day of surgery based on set criteria. Post-discharge remote follow-up was performed using a mHealth app at site 1 and scheduled telephone calls at site 2 up to postoperative day (POD) 7. The main outcome for this study was the success rate of SDD, defined as discharge on POD0 without emergency department (ED) visit or readmission within the first 3 days.

Results: A total of 105 patients were recruited (site 1, n = 70; site 2, n = 35). Overall, 75% of patients were discharged on POD0 (site 1 81% vs. site 2 63%, p = 0.038), of which only two patients required an ED visit within the first 3 days, leading to an overall success rate of 73% (site 1 80% vs. site 2 60%, p = 0.029). The incidence of 30-day complications (16% vs. 20%, p = 0.583), ED visits (11% vs. 11%, p = 1.00), and readmissions (9% vs. 14%, p = 0.367) were similar between the two sites. There was only one patient at each study site that went to the ED without instructions through remote follow-up.

Conclusions: A high proportion of patients planned for SDD were discharged on POD0 with few patients requiring an early unplanned ED visit. These results were similar with an mHealth app or telephone calls for post-discharge remote follow-ups, suggesting that SDD is feasible regardless of the method of post-discharge remote follow-up.

Keywords: Ambulatory colectomy; Colorectal surgery; Enhanced recovery; Same day discharge.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aftercare / methods
Colorectal Surgery*
Humans
Multicenter Studies as Topic
North America
Patient Discharge
Patient Readmission
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Prospective Studies
Retrospective Studies
Telemedicine*
Telephone