Safety and Feasibility of Ambulatory and Early Discharge Colectomy: A Systematic Review and Meta-Analysis

Abstract Background Ambulatory and early discharge pathways after colectomy are gaining interest for resource optimization, although evidence regarding safety, feasibility, and outcomes is heterogeneous. Aims The aim of this study was to assess the safety of ambulatory and early discharge colectomy and optimal feasibility pathway. Methods A systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search of major bibliographic databases identified studies evaluating ambulatory or short stay colectomy. The primary outcome was 30-day hospital readmission. Secondary outcomes included postoperative complications, reoperation, mortality, length of hospital stay (LOS), and healthcare costs. Comparative analyses were performed between early discharge and inpatient cohorts when data were available. Results A total of 41 studies were included in the qualitative synthesis, and 37 studies comprising 191,898 patients were included in the quantitative analysis. Successful early discharge was achieved in 1,290 of 3,006 patients (42.9%). Overall readmission occurred in 7,308 of 140,139 patients (5.24%). Readmission rates were comparable between patients discharged within 24 hours and inpatients (4.62% vs 5.21%; OR 0.83, 95% CI 0.63–1.09), with no clinically relevant increase associated with early discharge. Postoperative mortality was low (0.1%) and did not differ between groups. Reoperation (1.2%), surgical site infection (2.2%), and postoperative ileus (2.1%) rates were infrequently reported but remained low overall. LOS was significantly shorter in the early discharge group (0.8 ± 0.4 vs 3.8 ± 2.7 days). Economic analyses consistently demonstrated lower costs associated with early discharge pathways, with a crude weighted saving of USD 5,809 per patient. Conclusion In carefully selected patients, ambulatory and early discharge colectomy appears safe and feasible, with readmission, reoperation, and mortality rates comparable to standard inpatient management, alongside a marked reduction in LOS and substantial cost savings. These findings support the implementation of structured early discharge pathways in selected populations, while emphasizing the importance of patient selection and postoperative surveillance.