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

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

Research highlights
► Same-day discharge for laparoscopic gynecologic oncology surgery is feasible.
► Surgical patients with same-day discharge had low rates of readmission to hospital.
► Outpatient para-aortic lymphadenectomy or radical hysterectomy can be done safely.