Laparoscopic Surgery for Endometrial Cancer: Why Don’t All Patients Go Home the Day After Surgery?

Study ObjectiveTo identify risk factors for hospital length of stay (LOS) longer than 1 postoperative day in patients undergoing laparoscopic hysterectomy because of endometrial cancer.DesignRetrospective observational study (Canadian Task Force classification II-2).SettingTertiary-care university hospital.PatientsOne hundred thirty-three patients undergoing laparoscopic hysterectomy because of endometrial cancer between August 2006 and August 2010.InterventionsOne hundred thirty-three women underwent traditional laparoscopy. In 101 of these patients, lymph node sampling was performed.Measurements and Main OutcomesSeventy-four women (55%) were discharged on postoperative day 1. The percentage of women discharged on postoperative day 1 (POD1) vs after POD 1 did not differ by extent of staging. Risk of perioperative complications was associated with hospital LOS longer than POD1 (odds ratio [OR], 11.45; 95% confidence interval [CI], 1.40–94.39). Procedure start time after 3:00 pm (OR, 3.20; 95% CI, 1.14–9.04) and procedure end time after 5:00 pm (OR, 2.47; 95% CI, 1.17–5.20) were independent factors associated with hospital LOS beyond POD1. There was a nonsignificant tendency toward later hospital discharge with administration of intravenous narcotic agents.ConclusionsLaparoscopic surgery to treat endometrial cancer should be preferentially scheduled early in the day to facilitate discharge on POD1. The extent of staging lymphadenectomy performed does not increase hospital stay beyond POD1.