Short-term Outcomes of Day-Case Stoma Closure: A Prospective, Observational Study
Résumé
BACKGROUND: Elective stoma closure is a common, standardized procedure in digestive surgery. OBJECTIVE: This study aimed to evaluate the feasibility of day-case surgery for elective stoma closure. DESIGN: This is a prospective, single-center, nonrandomized study of consecutive patients undergoing day-case elective stoma closure. SETTING: This study was performed at a French tertiary hospital between January 2016 and June 2018. PATIENTS: Elective stoma closure was performed by local incision with an ASA score of I, II, or stabilized III. OUTCOME MEASURES: The primary end point was the day-case surgery success rate in the overall population (all patients having undergone elective stoma closure) and in the per protocol population (patients not fulfilling any of the preoperative or perioperative exclusion criteria). The secondary end points (in the per protocol population) were the overall morbidity rate (according to the Clavien-Dindo classification), the major morbidity rate (Clavien score >= 3), and day-case surgery quality criteria (unplanned consultation, unplanned hospitalization, and unplanned reoperation). RESULTS: Between January 2016 and June 2018, 236 patients (the overall population; mean +/- SD age: 54 +/- 17; 120 men (51%)) underwent elective stoma closure. Fifty of these patients (21%) met all the inclusion criteria and constituted the per protocol population. The day-case surgery success rate was 17% (40 of 236 patients) in the overall population and 80% (40 of 50 patients) in the per protocol population. In the per protocol population, the overall morbidity rate was 30% and the major morbidity rate was 6%. Of the 40 patients with successful day-case surgery, the unplanned consultation rate and the unplanned hospitalization rate were both 32.5%. There were no unplanned reoperations. LIMITATIONS: This was a single-center study. CONCLUSION: In selected patients, day-case surgery for elective stoma closure is feasible and has acceptable complication and readmission rates. Day-case elective stoma closure can therefore be legitimately offered to selected patients. See Video Abstract at http://links.lww. com/DCR/B583.