BEYOND LENGTH OF STAY: PROSPECTIVE COMPARISON OF FUNCTIONAL RECOVERY AND READINESS FOR DISCHARGE AFTER LAPAROSCOPIC VERSUS OPEN COLORECTAL CANCER RESECTION

Abstract

Objective: To prospectively compare functional recovery and time to readiness for discharge between patients undergoing laparoscopic versus open colorectal cancer resection, and to determine whether the operative approach is independently associated with time to readiness for discharge after adjustment for clinically relevant confounders. Study Design: Prospective comparative observational study. Settings: Department of Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: January 2026 to April 2026. Material & Methods: Sixty-four adult patients undergoing elective curative-intent colorectal cancer resection were enrolled by non-probability purposive sampling and allocated to Group A (completed laparoscopic resection, n=32) or Group B (planned open resection, n=32) according to the treating surgical team’s routine clinical decision. A blinded data collector recorded the first postoperative day on which oral intake, bowel function, oral analgesic pain control, independent mobility and clinical stability were achieved; functional recovery day and clinical readiness-for-discharge day were derived from these prespecified milestones. Normally distributed continuous variables were compared using the independent-samples t-test, skewed continuous recovery variables using the Mann-Whitney U test, and categorical variables using the Chi-square or Fisher’s exact test. Multivariable linear regression, adjusted for age, ASA grade, tumour site and stoma formation, evaluated the independent association between operative approach and time to readiness for discharge. p≤0.05 was taken as significant. Results: Baseline age, gender, BMI and ASA grade were comparable between groups (p>0.05). Median time to readiness for discharge was 3.0 days (IQR 2.0–3.2) in the laparoscopic group versus 4.5 days (IQR 4.0–5.0) in the open group (Mann-Whitney U=139.5, p<0.001). Functional recovery (3.0 vs 4.0 days, p<0.001) and postoperative length of stay (3.7±1.2 vs 5.2±1.3 days, p<0.001) were also significantly shorter after laparoscopy. Seventy-five percent (24/32) of laparoscopic patients were ready for discharge by postoperative day 3 versus 12.5% (4/32) after open surgery (χ²=22.92, p<0.001; risk ratio 6.0, 95% CI 2.35–15.33). Discharge delay beyond the day of readiness was similar between groups (0.62 vs 0.56 days, p=0.721). On multivariable regression, laparoscopic approach remained independently associated with earlier readiness for discharge (β=–1.68 days, 95% CI –2.26 to –1.09, p<0.001), independent of age, ASA grade, tumour site and stoma formation. Conclusion: Laparoscopic colorectal cancer resection was independently associated with significantly faster functional recovery and readiness for discharge than open resection, and this advantage was not explained by earlier hospital discharge processing. Readiness-for-discharge measurement can complement length of stay as a locally relevant, recovery-focused outcome for perioperative pathway design.