Day 1 Discharge for All Patients After Minimally Invasive Colon Surgery: A Prospective Cohort Study

BACKGROUND: Minimally invasive surgery and Enhanced Recovery After Surgery protocols enable discharge within 1 to 3 days after colon surgery. However, despite accumulating evidence, routine implementation of discharge within 24 to 72 hour remains variable and often limited outside specialized pathways. To address this, our center implemented a clinically guided Day-1 discharge pathway, in which Day 1 discharge was the default target for all eligible patients. OBJECTIVE: To evaluate the feasibility and safety of a clinically guided Day-1 discharge pathway for all eligible patients undergoing minimally invasive colon surgery. DESIGN: Prospective cohort study from March 2020 to December 2024. SETTINGS: Tertiary colorectal center. PATIENTS: All adult patients who underwent minimally invasive colon resection surgery without stoma formation were included. INTERVENTION: A clinically guided Day 1 discharge pathway was implemented in March 2020, in which Day 1 discharge was the default target for all eligible patients, with discharge pursued when predefined clinical criteria and patient willingness were met. MAIN OUTCOME MEASURES: Primary outcome was safety and feasibility of standardized Day 1 discharge, assessed through Day 1 discharge rates in conjunction with 30-day readmissions, severe complications (Clavien-Dindo ≥IIIb), and failure to rescue. Secondary outcomes included changes in discharge practices over time and factors associated with readmissions, severe complications, or Day 1 discharge. RESULTS: A total of 549 patients were included (33.2% aged ≥ 75 years). Median length of stay decreased from 3.0 to 1.0days (p < 0.001). Day 1 discharge increased from 4.6 to 65.0% (p < 0.001), with no significant changes in 30-day readmission (p = 0.43) or severe complication rates (p = 0.91). No preventable failure to rescue after discharge was identified. No patient characteristics were associated with increased readmissions or severe complications. Day 1 discharge rates increased steadily over time and were sustained, with discharge decisions progressively guided by individual postoperative recovery rather than fixed patient characteristics. LIMITATIONS: Single-center, non-randomized design limits causal inference and generalizability. Low event rates reduced power for subgroup analyses. CONCLUSIONS: Standardized Day 1 discharge is feasible and safe for patients undergoing elective minimally invasive colon surgery without stoma formation. See Video Abstract.