Improvement of peri-operative patient management to enable outpatient colectomy.
OBJECTIVE
Outpatient left colectomy has been described in several small series or case reports. We conducted a prospective study to determine whether an optimized management approach could allow performance of this procedure in a broader patient population.


METHODS
Between December 2014 and December 2015, all eligible patients were prospectively and consecutively included in this study. They all underwent surgery following the same outpatient management protocol. After discharge, patients were followed by home health nurses with surgeon follow-up visits on days 10 and 21 (D10, D21) or earlier, if necessary.


RESULTS
During this period, 56 patients underwent a left colectomy, 47 of whom met the inclusion criteria. Seven patients refused the outpatient care approach, leaving a total of 40 patients included (8 ASA 3 [American Society of Anesthesiologists], 24 ASA 2, 8 ASA 1). All but one of the patients were able to return home the same evening. Bowel motility was restored on D1 for most patients. Two patients had abdominal pain that required a follow-up visit before D10 but their subsequent course was uneventful. No patient was re-hospitalized. An uncomplicated post-operative course was confirmed at follow-up visits on D10 and D21.


CONCLUSIONS
Our study confirms that outpatient left colectomy is feasible for most patients, including fragile patients and/or those undergoing more complex procedures. Communication and close coordination by all stakeholders as well AS optimal organization of downstream patient care are essential to guarantee quality and safety.
Digestive and Endocrine Surgery, hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 Le Havre, France. Electronic address: philippe.chasserant@wanadoo.fr.
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P
Chasserant
Anesthesiology Service, hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 Le Havre, France.
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M
Gosgnach
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement; D013997:Time Factors
Ambulatory surgery; Left colectomy; Quality; Safety