Implementation of a Same-Day Discharge Protocol Following Total Laparoscopic Hysterectomy

Nensi, Alysha; Coll-Black, Mary; Leyland, Nicholas; Sobel, Mara

doi:10.1016/j.jogc.2017.05.035

Cited by 32 publications

(20 citation statements)

References 14 publications

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“…This was largely because of concerns for postoperative pain control and patient safety [2]. However, with the widespread use of minimally invasive surgical procedures and proper patient selection, outpatient hysterectomies are feasible in more than 80% of cases [3]. Outpatient procedures improve postoperative recovery and reduce institutional cost without increasing the risk for postoperative complications [4,5].…”

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confidence: 99%

Predictors of Postoperative Urinary Retention in Outpatient Minimally Invasive Hysterectomy

Behbehani

Delara

et al. 2020

Journal of Minimally Invasive Gynecology

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To identify risk factors associated with postoperative urinary retention in patients undergoing outpatient minimally invasive hysterectomy. Design: A retrospective cohort study. Setting: An academic medical center. Patients: All patients undergoing outpatient minimally invasive hysterectomy between January 2013 and July 2018 were considered for inclusion in the study. Interventions: Outpatient laparoscopic, vaginal, or robotically assisted laparoscopic hysterectomy. Measurements and Main Results: Four hundred forty-four patients met the inclusion criteria. Postoperative urinary retention occurred in 94 patients, and 347 patients successfully passed their voiding trial in the postanesthesia care unit for a pass rate of 79%. Demographic characteristics were similar, except patients who experienced postoperative urinary retention were less likely to be menopausal (23.4% vs 34.7%, p = .038). Those with urinary retention received more perioperative opioids (morphine milligram equivalent of 14.4 mg vs11.2 mg, p = .012), had longer operative times (122.9 § 55.6 vs 95.7 § 42.3 minutes, p < .01), and experienced more blood loss (105.3 § 134.4 vs 78.5 § 86.8 mL, p = .025). The rate of urinary tract infections was similar. Logistic regression analysis showed that the route of hysterectomy and age were not associated with an increased risk for urinary retention, whereas a longer operative time and higher doses of perioperative opioid use were. Conclusion:In patients undergoing minimally invasive outpatient hysterectomy, a longer operative time and increased perioperative narcotic use increases the risk of postoperative urinary retention.

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confidence: 99%

Predictors of Postoperative Urinary Retention in Outpatient Minimally Invasive Hysterectomy

Behbehani

Delara

et al. 2020

Journal of Minimally Invasive Gynecology

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“…This has been illustrated in the case of the cesarean delivery in which the joint commission began reporting cesarean delivery rates of hospitals to improve quality metrics [26]. The addition of standardized protocols that incorporate patient education materials have improved the ability to discharge patients the same day of surgery [27]. Thus, through education of both the physician and the patient, as well as through tracking SDD by quality metrics and a standardization of procedures, SDD can be encouraged and implemented throughout multiple hospital systems.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Same Day Discharge after Laparoscopic Surgery in Gynecologic Oncology

Brancazio¹,

Lehman

Kemp

et al. 2022

Journal of Minimally Invasive Gynecology

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To identify factors associated with same day discharge (SDD) after laparoscopic surgery in gynecologic oncology. Design: Retrospective cohort. Setting: Teaching hospital. Patients: Total of 800 patients having minimally invasive surgery in the division of gynecologic oncology during a 20month period. Intervention: Minimally invasive surgery cases were reviewed for determinants of SDD to identify factors that could improve the SDD rate. Measurements and Main Results: During the study period, 800 minimally invasive procedures were performed with a 43.0% SDD rate. Patients who had SDD were younger (52.3 years vs 58.0 years; p <.001), had a lower body mass index (31.1 kg/m 2 vs 33.7 kg/m 2 ; p <.001), were less likely to have a malignancy (28.2% vs 55.5%; p <.001), had a lower estimated blood loss (36 vs 72 mL; p <.001), and were more likely to have received an enhanced recovery after surgery protocol (49.8% vs 39.3%; p <.003). Total surgical time was shorter in women with SDD (156 minutes vs 208 minutes) as was total narcotic use in morphine equivalents (MEq) (milligram intravenous MEq, 23.1 mg MEq vs 28.8 mg MEq). SDD was also associated with earlier start time (p <.001). Laparoscopic cases were most likely to have SDD (51.4%) as compared with robotic assisted surgery (16.1%) or minilaparotomy (10.5%). There was a wide range of SDD among surgeons ranging from 19.8% to 56.2% (p <.001). In a multivariate analysis, the factors predicting SDD in order of predictive factors were surgical time (p <.001), recovery time (p <.001), start time (p <.001), surgeon (p <.001), age (p <.001), estimated blood loss (p <.001), and type of surgery (p = .005). Conclusion: Multiple factors affect SDD. Modifiable factors for SDD include the start time, surgeon preference, and patient expectations for SDD. Given these data, centers should prioritize surgical order by which patients are more likely to go home, and surgeons should analyze their own data with respect to achieving higher SDD rates.

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“…Following imple-mentation of a same-day discharge protocol for laparoscopic hysterectomy, a prospective cohort study found the average length of stay was significantly lower with no increase in intraoperative or postoperative complications or readmission rates. 6 A retrospective observational study demonstrated that outpatients did not experience greater rates of 30-day morbidity, compared with patients admitted to the hospital. 7 Laparoscopic hysterectomy is cost-effective relative to the abdominal route.…”

Section: Why This Route: Benefits Of Laparoscopymentioning

confidence: 99%

Route of Hysterectomy: “Straight-Stick” Laparoscopy

Carrubba

McKee

Wasson

2021

Journal of Gynecologic Surgery

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The laparoscopic, or ''straight-stick'' approach to hysterectomy accounts for *30% of hysterectomies performed. Enhanced magnification and visualization, decreased blood loss, and fewer complications have made laparoscopic hysterectomy a preferred approach and the modality recommended by the American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists when vaginal hysterectomy is not possible. Laparoscopic hysterectomy is ideal for managing fibroids, adnexal masses, and endometriosis by providing excellent visualization of the pelvis while offering the benefits of minimally invasive surgery. Large pathologies, such as fibroids or adnexal masses, can be navigated safely using an angled laparoscope. In patients undergoing surgery for pelvic pain, laparoscopy allows the surgeon to inspect the abdomen fully to determine if anatomical abnormalities or pathology are present. The laparoscopic approach is useful for patients who desire supracervical hysterectomy and for those having concomitant pelvic support procedures such as sacrocolpopexy. Advantages of laparoscopic hysterectomy include the ability to allow same-day discharge with no increase in intraoperative or postoperative complications, readmission rates, or 30-day morbidity, compared with patients admitted to the hospital. Patients are able to return to normal activities sooner and experience decreased postoperative pain, compared to patients who undergo abdominal hysterectomy. Shorter hospitalization and decreased complications have also enabled the laparoscopic approach to become more costeffective than the abdominal approach. To facilitate a safe and effective laparoscopic hysterectomy regardless of surgical complexity, the surgeon must be comfortable with adhesiolysis, retroperiteoneal dissection, and suturing. There are several limitations to laparoscopy, including numerous prior surgeries, extensive pathology, comorbidities, and concern for malignancy. In these cases, an alternative route to hysterectomy may be preferred. Many of these challenges may be overcome with alternative entry points, modifications to trocar placement, an angled lens, and appropriate instrument selection. Surgeons who perform laparoscopic hysterectomy must anticipate potential concerns and consider patient-specific characteristics carefully when choosing this route of surgery. Surgeon skillset and expertise is essential to performance of straight-stick hysterectomy ( J GYNECOL SURG 37:107

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Implementation of a Same-Day Discharge Protocol Following Total Laparoscopic Hysterectomy

Cited by 32 publications

References 14 publications

Predictors of Postoperative Urinary Retention in Outpatient Minimally Invasive Hysterectomy

Predictors of Postoperative Urinary Retention in Outpatient Minimally Invasive Hysterectomy

Factors Associated with Same Day Discharge after Laparoscopic Surgery in Gynecologic Oncology

Route of Hysterectomy: “Straight-Stick” Laparoscopy

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