Open AccessSafety of hospital discharge before return of bowel function after elective colorectal surgery
Author(s) -
Stephen J. Chapman,
Ruth BlancoColino,
S Pérez-Ajates,
O Anabitarte Bautista,
James Hodson,
James Glasbey,
Francesco Pata,
Gianluca Pellino,
AS Soares,
T. van Elst,
Stephanie Van Straten,
Dmitri Nepogodiev,
Aditya Borakati,
M F Bath,
Ifat Yasin,
Kenneth A McLean,
Thomas Arthur,
M Kovacević,
S Delibegovic,
Martin Karamanliev,
Mohamed Swamad,
R Žebrák,
R Paramasivam,
A Martensen,
Helene Mathilde Larsen,
Lukas Rädeker,
PiaElena Frey,
Aristotelis Kechagias,
Aurélien Venara,
Émilie Duchalais,
Argyrios Ioannidis,
Sandro Pasquali,
Andrea Simioni,
Valeria Farina,
Mauro Podda,
Laura Lorenzon,
ItSURG,
V. Schaeff,
Amy D. Otto,
Matas Jakubauskas,
T. R. van Elst,
Michael J. J. Chu,
Paul Fagan,
Cameron I. Wells,
A Alagoa João,
António Sampaio Soares,
Jovan Juloski,
Y. El Kasmy El Kasmi,
Eloy Espín,
Daniel Clerc,
Cezar Ciubotaru,
S S Popescu,
A Yanishev,
S Lee,
Bahar Büşra Özkan,
A Yagız Sen,
M K Aktas,
Bahadır Emre Baki,
B Yüksek,
Sivesh K. Kamarajah,
Rachel A Khaw,
Emily Mills,
R. Goodson,
Nimish Thakral,
Andrew D. Ablett,
M Adra,
I Kwek,
S. Khan,
Patrick Quinn,
L R Manley,
Abdul Badran,
A Ramjeeawon,
A Campbell,
Haiyan Tan,
Dupinderjit Rye,
Nikitha Rajaraman,
James G. Norman,
Kritchai Vutipongsatorn,
Georgios Solomou,
Melika Akhbari,
Ased Ali,
B D Brandao,
B Stainer,
Rachel Thavayogan,
D. Jones,
Oluwatobi Onafowokan,
A Gharooni,
N Dabab,
S Carlton-Carew,
Garikai Kungwengwe,
Melissa Gabriel,
Emma Sewart,
T Shortland,
Samuel Lawday,
Peter Pockney,
Amanda Dawson,
Peter Stewart,
Benjamin Ng,
Jason Luong,
V. A. Ivanov,
Anna V. Borisova,
V Neykov,
M Farkašová R Žebrák,
J L Harbjerg,
Søren Brandsborg,
Anders MarkChristensen,
K P Unbehaun,
Peter Dalsgaard,
Kathrine Dyhr Lycke,
P LeNaoures,
Cécile Brigand,
E. Dumange,
M Gout,
C Moehwald,
M Prem,
Omar Alhalabi,
S Sliwiński,
Johannes Krupp,
Eva Gablenz,
L Schmitzer,
A. Kopp,
John G. Steinle,
Julia Gsenger,
L J Pohl,
Mariagrazia Riccardi,
I M Christodoulou,
M. Konstantinidis,
Nikolaos Machairas,
Athanasios Zoikas,
Dimitrios Balalis,
Dimitrios K. Manatakis,
M L Aguilera,
Luigi Marano,
Francesco Fleres,
Federico Lovisetto,
Diego Sasia,
Edoardo Segalini,
Giacomo Pata,
Andrea Lucchi,
Andrea Sagnotta,
Tommaso Campagnaro,
Filippo Petrelli,
Gaetano Gallo,
Matteo Papandrea,
Valentina Testa,
Giovanni Sinibaldi,
Francesca Di Candido,
F. Colombo,
Gennaro Perrone,
S Aresu,
Alessia Biancafarina,
Giuseppe Caico,
Michele Pagnanelli,
Gianluca Curletti,
Roberto Bini,
A De Manzoni Garberini,
Harmony Impellizzeri,
Nicola Cillara,
Roberta Tutino,
Arcangelo Picciariello,
Diego Coletta,
Gustavo Savino,
Francesco Ferrara,
Nicolò Tamini,
Giuseppina Talamo,
Dario Parini,
P. Giamundo,
Gennaro Pagano,
V. Ripetti,
Antonio Pesce,
Nunzia Menduni,
Rosina Giudicissi,
Ehud Goldin,
Daniela Rega,
Antonio Belli,
Valeria Andriola,
Luca Gordini,
Caterina Foppa,
Gaetano Piccolo,
Arianna Birindelli,
Cecilia Ferrari,
Zeno Ballarini,
Flavio Tirelli,
Marco Milone,
Michele De Rosa,
N S Pipitone Federico,
Beatrice Molteni,
Pier Luigi Tilocca,
Giulio Sancini,
Guglielmo Niccolò Piozzi,
Andrea Lauretta,
Silvia Mulas,
Dainius Šimčikas,
L Portelli,
J. W. M. van Wijnbergen,
T L Dinger,
S. F. H. ten Doesschate,
Anne Sophie H.M. van Dalen,
D. D. van den Bos,
MartinLeo Hansmann,
J Medina Feliz,
Sara Z. Kuiper,
Ziena Abdulrahman,
S R Pruijssers,
V P Geneta,
Stephen B. Wilton,
H Kandelaki,
Shuang Peng,
Simon Campbell,
Yee-Wei Lim,
Shahed Yassaie,
Michael J. Murray,
Cheyaanthan Haran,
J Tan,
João Pimenta de Castro,
Álvaro Laranjeira,
Susana O. Catarino,
C Neves-Marques,
J. G. Correia,
Bárbara Vieira,
Catarina Quintela,
Marta Serra,
J Maciel,
Miguel F Cunha,
David Aparício,
José Farela Neves,
José Azevedo,
Manuela Romano,
F Eiró,
Joana Romano,
Cristina Monteiro,
M Claro,
Almeida,
Mariana Peyroteo,
N D Machado,
Hugo Capote,
Margarida Ferreira,
Xavier de Sousa,
Helena Devesa,
Demetrio Cavadas,
I Guerreiro,
Maria Laura Costa,
Manuel Rosete,
M Salman,
C English,
N Mohammed,
Andrey Litvin,
V Cuk,
K Mészárosová,
Robert Jaich,
Henrique Lima,
Savannah Brooks,
M. Marx,
M Nshalati Salvation,
Juan García Cardo,
Ismael MoraGuzmán,
Jorge Sancho Muriel,
U De Andres Olabarria,
Pablo Muriel,
Clara Viñas,
Felipe Alconchel,
O Esteban Sinovas,
C. Fairén Oro,
M. López Otero,
S. Figueroa Jiménez,
O. Claramonte Bellmunt,
J Martínez Caballero,
Inés Rubio-Pérez,
M. M. Aguilar-Martínez,
Juan José SeguraSampedro,
Colmenares Moreno,
D. Negre Parra,
A. M. Estévez Diz,
Ramón Martín-Balbuena,
C Bustamante Recuenco,
Ricardo Bolaños,
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Helena Salvador Rosés,
Pedro VillarejoCampos,
C. C. Lopes Moreira,
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M Serrano-Navidad,
Javier RipollésMelchor,
Alessandro Garcea,
Helena Facundo,
P Troncoso Pereira,
C. V Pérez Guarinos,
Benjamin Blaser,
Giulia Piazza,
Barbara Sara Alessandra Gagliardi,
H Serin,
S S Yurdaor,
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O Kopac,
Abdullah Uyanık,
Berk B. Özmen,
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Kathryn M. Scanlon,
Nicholas O’Dwyer,
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Arpád Panyko,
Sandy van Vuuren,
Ann Centeno,
Isabel Ramos Bernadó,
Marta Paniagua García-Señoráns,
L. González Amor,
María D. Cuenca Ramírez,
Jesús Abrisqueta,
Madeleine Gomez,
Antonio Arroyo,
C.M. Mateo Cerdán,
Núria Gómez,
José M. Enríquez–Navascués,
Francesc Collado-Roura,
P. Curchod,
S Gaspar,
L Imadalou,
Derya Mutlu,
Cihangir Akyol,
Furkan Ali Uygur,
İsmail Cem Eray,
O Biyiklioglu,
Mustafa Çetin,
Bora Karıp,
Hakan Doğan,
L Sarıgül,
Şevket Ercan Tunç,
T. Aydin,
Muhammed Selim Bodur,
Koray Karabulut,
Abraham Francis,
Ali Al-Hadithi,
I.S. Lau,
Elliot Smith,
Smita Mahapatra,
Olivia McAuliffe,
Lema Imam,
Bisma Akram,
Sina Hossaini,
R. Davies,
M Ko,
Jorja Collins,
A Pandya,
Steven K. Reilly,
James E. Archer,
J Livie,
Farrukh A. Chaudhry,
E Ntakomyti,
Rama Diallo,
T. Bylinski,
Jenny Wright,
Erfan Masiha,
Jeanne Tung,
B Shirazi,
A Neilson,
Sarah Epton,
N Patel,
Shaun Trussell,
A Couldrey,
C. Donnelly,
S Eftychiou
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11422
Subject(s) - medicine , ileus , bowel function , surgery , odds ratio , colorectal surgery , prospective cohort study , bowel resection , abdominal surgery
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.
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