Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology

Objective

The purpose of this study is to evaluate whether same-day discharge after laparoscopic gynecologic oncology surgery is feasible and determines factors associated with admission.

Methods

This retrospective cohort study included all patients consented for laparoscopy by two gynecologic oncologists at a tertiary care academic teaching hospital between January 2006 and June 2009. Procedures included those not typically discharged same-day, such as total laparoscopic simple or radical hysterectomies or radical trachelectomy +/− salpingo-oophorectomy +/− pelvic and para-aortic lymph node dissection +/− omentectomy. Those discharged same-day were compared to those admitted. Multivariate logistic regression analysis was done to determine factors associated with admission.

Results

Three hundred three patients were included. 6.9% were converted to laparotomy. One hundred forty-seven (48.5%) had same-day discharge (median stay 295 minutes). Among outpatients, 7 (4.8%) were readmitted within three weeks of surgery. Three patients (2%) could have avoided the ER or hospital admission had they been originally admitted postoperatively. No patients with same-day discharge had a major acute postoperative complication. Factors associated with admission include age (OR 1.76 for age 70 years vs 50 years, p = 0.001), surgeon (OR 6.91, p < 0.0001), conversion to laparotomy (p < 0.0001), radical hysterectomy (OR 3.43, p = 0.002), length of surgery (OR 2.94 for 4 hours vs 2 hours, p < 0.0001), and surgery start time after 1 PM (OR 3.77, p = 0.0001).

Conclusion

Same-day discharge for laparoscopic gynecologic oncology surgery is feasible, with low morbidity and few readmissions within three weeks of surgery. Successful same-day discharge can increase by refining patient selection and operating room scheduling.