Early discharge following colorectal surgery is advocated. But clinical and/or laboratory criteria determining safe early discharge is lacking.

A prospective, single-centre cohort study evaluated the diagnostic performance of a C-reactive protein (CRP) level blended with 4 clinical criteria to discard an anastomotic leak and thus allow an early discharge on a postoperative day 2 or 3.

Adult patients undergoing laparoscopic colorectal surgery were enrolled for the study and were followed up for 30 days postoperatively. 

It was checked whether the 5 discharge criteria were fulfilled on postoperative day 3 (or day 2 for patients discharged on day 2). Fulfillment was described as a CRP level<150 mg/dL on the day of discharge, a return of bowel function, tolerance of a diet, pain <5 of 10 on a visual analog scale, and being afebrile during the entire stay.

The diagnostic performance of the 5 discharge criteria in anticipating anastomotic leak development was assessed. Further, the diagnostic performance of CRP level individually and 4 clinical criteria independently were also evaluated.

Assessment of anastomotic leaks and mortality rates up to postoperative day 30 were the secondary outcomes. A discharge was said to be successful if the patient left the hospital on a postoperative day 2 or 3 without any complications or readmissions.

The following were the observations of the study-

• 287 patients were enrolled for the study.
• The median age of the subjects was 58 years.
• 49% of the enrolled participants were men while 51% were women. 
• 0% Mortality was observed. 
• 17 anastomotic leaks were observed, 2 of which occurred on day 1 and were excluded. 
• 128 patients fulfilled all criteria.
• 2 leaks were demonstrated in patients who had fulfilled all criteria vs 13 leaks in patients who did not.
• 59.4% of the patients who fulfilled all criteria were discharged successfully by postoperative day 3. 
• The negative predictive value in ruling out an anastomotic leak was at least 96.9% for CRP alone, the 4 clinical criteria, and all 5 criteria combined. 
• False-negative rates were 40%, 20% and 13.3% for CRP level alone, the other 4 criteria, and for all 5 criteria, respectively.

Thus the described 5 criteria have a high negative predictive value and the lowest false-negative rate, suggesting their potential to allow for safe early discharge after laparoscopic colorectal surgery.

Source- JAMA Surg. 2022 Jan 1;157(1):52-58.  doi: 10.1001/jamasurg.2021.5551.