Early Discharge after Elective Colorectal Surgery: A Systematic Review

Abstract Length of hospital stay after colorectal surgery has decreased progressively with the adoption of enhanced recovery after surgery (ERAS) programs and minimally invasive techniques. Early discharge strategies, including discharge within 72 and 24 hours, as well as same-day discharge, have been increasingly implemented; however, concerns regarding safety and readmission persist. To systematically review the evidence on the feasibility and safety of early discharge after elective colorectal surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. The MEDLINE, Embase, and the Cochrane Library databases were searched for studies evaluating early discharge after elective colorectal surgery. Primary outcomes included 30-day readmission, postoperative complications, reoperation, and mortality. Secondary outcomes included length of stay and feasibility of early discharge targets. Observational cohorts and randomized studies conducted predominantly in ERAS-based settings were included. Discharge within 72 hours was consistently safe and widely achievable. Discharge within 24 hours, including evidence from a large cohort published in Colorectal Disease, was feasible in selected patients without increased major morbidity or mortality, with readmission rates generally ranging from 5 to 10%. Same-day discharge was achievable only in highly selected patients and required dedicated outpatient support. Early discharge after colorectal surgery is safe when embedded within structured perioperative pathways. Discharge within 24 hours represents a pragmatic intermediate strategy between conventional ERAS care and same-day discharge models and may be particularly relevant for centers seeking to optimize hospital bed utilization without compromising patient safety.