Safety and feasibility of early discharge (≤ 23 h) following loop ileostomy reversal: a systematic review and meta-analysis.

BACKGROUND

The standard practice for postoperative management of loop ileostomy reversal has been standard admission with several days of inpatient observation, largely to monitor for postoperative complications. These primarily include anastomotic leak, postoperative ileus, and surgical site infection. In recent years, several studies have piloted ambulatory or short-stay pathways; however, the safety and impact of these pathways on complications remains unclear.

METHODS

This systematic review and meta-analysis was conducted in accordance with PRISMA. It was also conducted in accordance with a prospectively registered protocol (PROSPERO CRD420251252408). Adults undergoing loop ileostomy reversal discharged within 23 h of surgery (including same-day discharge (SDD), short-stay protocols (LOS 1)) were compared with patients managed with standard admission. Primary outcomes were anastomotic leak, postoperative ileus, and surgical site infection at 30 postoperative days; secondary outcomes included readmission, overall complications including Clavien-Dindo-graded events, and mortality. Random-effects models were used to pool odds ratios with 95% confidence intervals.

RESULTS

Twelve studies (11 retrospective cohort studies, 1 RCT), comprising 30,040 patients were included. Of these, 2611 (8.7%) patients underwent ambulatory or short-stay reversal. There was no significant difference between early discharge and standard cohorts in anastomotic leak (pooled OR 1.31, 95% CI 0.24-7.32), postoperative ileus (pooled OR 0.49, 95% CI 0.16-1.55), or surgical site infection (pooled OR 0.76, 95% CI 0.38-1.51). However, the low event rates and wide Cis likely preclude confident exclusion of a clinically meaningful effect. Similarly, readmission rates showed no difference between groups (pooled OR 0.97, 95% CI 0.78-1.19). Early discharge following reversal was, however, associated with a modest but statistically significant reduction in overall postoperative complications (pooled OR 0.70, 95% CI 0.50-0.98), with comparable rates of major (Clavien-Dindo III-IV) complications and very low mortality in both groups.

CONCLUSIONS

This study suggests that early discharge following loop ileostomy reversal, if carried out as part of a structured perioperative pathway, appears to be safe, with no apparent increase in risk of any additional postoperative complications. However, the data available at present is dominated by largely retrospective cohort studies, with heterogenous discharge criteria, and inconsistency in intervention (SDD vs 23 h stay vs short-stay protocol), precluding any firm conclusions regarding equivalence with standard admission. Rather than advocating for its widespread adoption, these findings support the cautious implementation of early discharge pathways in select cohorts with prospectively collected outcomes. Adequately powered multicentre RCTs with standardisation of intervention and outcome measures are required before broader dissemination can be recommended.

CLINICAL TRIAL REGISTRATION: Not applicable. This study is not a clinical trial.