Feasibility of Same-Day Discharge in Patients Undergoing Laparoscopic Gynecologic Oncology Surgery.

Abstract

Objective: To evaluate the safety and feasibility of same-day discharge (SDD) of oncology patients undergoing complex laparoscopic gynecologic oncology surgery.

Method: A retrospective review including patients from October 2019 to July 2023 undergoing surgical staging for endometrial, tubal, or cervical cancer, treatment for endometrial hyperplasia, or pelvic masses. Surgeries included a total laparoscopic hysterectomy. Patients accomplishing SDD were compared to those requiring admission. Data collection included clinical, demographical, and perioperative variables up to 6 weeks after surgery. Univariate and multivariate analyses were conducted.

Results: 152 patients were included. On multivariate analysis, variables that significantly predicted admission were an age ≥61 (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.102-0.642; P = 0.004), BMI ≥30-34.9 (OR, 0.291; 95% CI, 0.094-0.905), BMI ≥35 (OR, 0.207; 95% CI, 0.075-0.569; P = 0.002), operative time ≥181 minutes (OR, 0.143; 95% CI, 0.057-0.361; P < 0.001), and an operative start time after 2:00 PM or later (OR, .135; 95% CI 0.036-0.503; P = 0.003). A patient's location <1 hr. away from the center significantly increased the odds of SDD (OR, 2.50; 95% CI, 1.068-5.863; P = 0.035). Out of 51 patients who accomplished SDD, there was a <4% failure rate, with those who were discharged requiring admission >96 hours postoperatively. Of those admitted, the average length of stay was 1.09 days.

Conclusion: SDD is safe and feasible for patients. There are few complications, re-admissions, or unscheduled patient contact postoperatively. Its success can be increased by refining patient selection using predictive variables.