A new JAMA Surgery study has identified clinical and laboratory criteria based on which patients could be safely discharged early after laparoscopic colorectal surgery.

The prospective, single-center cohort study examined 287 patients who underwent laparoscopic colorectal surgery between February 2012 and July 2017 at a hospital in France. The follow up period was 30 days after surgery. Researchers defined five discharge criteria namely CRP level <150 mg/dL on the day of discharge, return of normal bowel function, tolerance for solid foods, adequate pain control using oral analgesics (pain <5 [out of 10 points] on a visual analog scale) and being afebrile during the entire duration of stay. The objective of the study was to assess the ability of these discharge criteria in predicting development of anastomotic leak and allowing patients to be discharged on the second or third postoperative day.

Analysis of data showed two leaks in patients who had fulfilled all five criteria compared to 13 leaks in patients who did not fulfil all criteria (hazard ratio [HR] 0.15). Nearly 60% of patients were discharged successfully by postoperative day 3 without any complications or readmissions.

The negative predictive value in excluding anastomotic leak was nearly 97% for CRP alone, 98.4% for the 4 clinical criteria and 98.4% for all five criteria combined. False-negative rates were 40% for CRP level alone, 20% for the other 4 criteria and 13.3% for all 5 criteria.

Anastomotic leaks are a distressing complication of colorectal surgery. This study has shown a high negative predictive value and the lowest false-negative rate of developing an anastomotic leak for all the five criteria. Addition of CRP to the clinical criteria facilitates identification of patients who can be safely discharged early after laparoscopic colorectal surgery.

Reference

1. Tavernier C, et al. Assessing criteria for a safe early discharge after laparoscopic colorectal surgery. JAMA Surg. 2021 Nov 3. doi: 10.1001/jamasurg.2021.5551