Inpatient vs. outpatient bowel preparation for elective colorectal surgery.
BACKGROUND
Recent pressures to decrease the cost of medical care have mandated preoperative outpatient bowel preparation (OBP) for elective colorectal surgery without any data documenting equivalent quality of care. This study examined the safety and efficacy of OBP compared with inpatient bowel preparation (IBP).


METHODS
Records of all patients who underwent OBP for elective colorectal resection since the inception of the OBP program from July 1993 to June 1994 were compared with records of all patients who received IBP for elective procedures from January to June 1993.


RESULTS
The two groups, 90 patients who underwent OBP and 98 patients who had IBP, were well matched for age, sex, diagnosis, and operations performed. The OBP group had a shorter length of hospital stay (median, 7 vs. 9 days; P < 0.0001; chi-squared analysis), whereas the complication rate was similar (19 percent in the OBP group vs. 18 percent in the IBP group), including infectious complications (10 percent in the OBP group vs. 7 percent in the IBP group). Although operating time was similar (mean, 199 vs. 213 minutes) and estimated blood loss (mean, 528 vs. 536 ml), the OBP group had significantly higher perioperative fluid requirements: intraoperative fluids (median, 4300 vs. 3700 ml; P < 0.05; Student's t-test), intraoperative colloid administration (48 vs. 29 percent; P < 0.0002; chi-squared), 24-hour postoperative fluids (3224 vs. 2700 ml; P < 0.0001; Student's t-test), and postoperative fluid challenges (50 vs. 20 percent; P < 0.0001; chi-squared analysis).


CONCLUSIONS
Outpatient bowel preparation for elective colorectal surgery is safe and effective. It offers shorter hospital stay, and, therefore, potentially reduces medical care cost. Patients with multiple medical problems may not tolerate extensive fluid shifts; therefore, other preoperative arrangements, such as inpatient or outpatient intravenous fluid therapy, need to be considered to minimize complications that may outweigh potential cost savings.
Lee
E C
EC
Department of Colon and Rectal Surgery, Lahey Hitchcock Clinic, Burlington, Massachusetts 01805, USA.
Roberts
P L
PL
Taranto
R
R
Schoetz
D J
DJ
Murray
J J
JJ
Coller
J A
JA
D000553:Ambulatory Care / Q000191:economics; D019072:Antibiotic Prophylaxis; D003106:Colon / Q000601:surgery*; D003363:Cost Control; D017558:Elective Surgical Procedures; D004573:Electrolytes / Q000008:administration & dosage; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010710:Phosphates; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000191:economics / Q000379:methods; D012007:Rectum / Q000601:surgery*; D007507:Therapeutic Irrigation; D013997:Time Factors
D004573:Electrolytes; C033608:Golytely; D010710:Phosphates; D011092:Polyethylene Glycols; C018279:sodium phosphate