The safety and trends of same-day and short-stay stoma closure: are we really on the verge of a paradigm shift?

BACKGROUND

The evolution of enhanced recovery pathways in colorectal surgery has enabled same-day discharge (SDD) in various procedures. Although early discharge after diverting loop ileostomy closure was first described in 2003, its adoption remains limited. This study aimed to analyze national trends in outpatient stoma closure; compare outcomes between SDD, short-stay (SS), and traditional inpatient (IP) protocols; and identify factors associated with safe early discharge.

METHODS

A retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program database was conducted. Patients who underwent elective stoma closure were included. The study population was divided into SDD (length of stay [LOS] of 0 days), SS (LOS of 1 day), and IP (LOS of ≥2 days) groups. The outcomes were analyzed using unadjusted, multivariate, and propensity score-matched analyses.

RESULTS

From 2017 to 2022, 22,312 patients were included: 201 (0.9%) in the SDD group, 1833 (8.2%) in the SS group, and 20,278 (90.9%) in the IP group. Overall morbidity was significantly lower in expedited discharge groups (7.0% in the SDD group vs 6.0% in the SS group vs 11.8% in the IP group; P <.001). After propensity score matching, both SDD and SS groups showed comparable safety outcomes, whereas the IP group had significantly higher reoperation rates. No differences in readmission rates were observed between the groups. American Society of Anesthesiologists class > III, smoking status, chronic obstructive pulmonary disease, steroid use, and dependent functional status were identified as independent risk factors for adverse outcomes.

CONCLUSION

Both SDD and SS discharge protocols for stoma closure are safe in appropriately selected patients. Despite evidence supporting their safety, their adoption remains limited. The identification of specific risk factors guides patient selection and suggests substantial opportunity for expanding the implementation of outpatient protocols.