Extraction Laparotomy for Specimen Retrieval Does Not Alter Same-Day Discharge Plans

Abstract

Study Objective

To evaluate whether extraction laparotomy (EL) for intact specimen removal adversely affected the feasibility or safety of same-day discharge (SDD) in patients undergoing minimally invasive surgery (MIS) for confirmed or suspected gynecologic malignancies.

Design

Retrospective study.

Setting

Single-institution study.

Patients

Patients undergoing MIS for gynecologic malignancy at a single institution, who underwent EL (N = 67) and age-matched controls (N = 134).

Interventions

Comparing SDD rates, complications, readmission, and outpatient follow-up after between patients requiring EL and those who did not after minimally invasive gynecologic surgery.

Measurements and Main Results

A total of 1224 patients were identified. Sixty-seven patients underwent EL for specimen extraction. From the remainder, 134 patients were selected as age-matched controls. SDD rate was 83% (EL) vs 87% (no EL) (p = .39). There was no difference in median pain scores (1.8 vs 1.9 p = .86), length of stay (0 days for both) (p = .41), 30-day readmission rate (6% vs 3%) (p = .45), emergency department visit (13% vs 10%) (p = .76), or any patient contact (34% vs 39%) (p = .53), between the groups. Specimen weight was higher for EL (524 g vs 142 g, p <.001), as was estimated blood loss (104 mL vs 46 mL, p <.001), and surgery time was increased by 22 minutes in the EL group (121 min vs 99 min, p <.001). Patients who underwent EL did require more narcotics in postanesthesia care unit (20.5 vs 12.2 oral morphine equivalent, p = .033); however, this did not translate to increased number of narcotics prescribed at discharge. On logistic regression, a higher specimen weight trended to increase the likelihood of admission (odds ratio, 1.04; confidence interval, 1.01–1.08); however, surgery time, time in postanesthesia care unit, race, body mass index, surgery type, or need for EL did not predict SDD or need for admission.

Conclusion

MIS patients who require EL can still achieve SDD. SDD is safe and feasible without increased risk of readmission, pain score, or unscheduled patient contact postoperatively.