Predictors of same‐day discharge after minimally invasive hysterectomy for benign indications

Abstract

Objective: To identify predictors of same-day discharge after benign minimally invasive hysterectomy. Methods:In this retrospective cohort study, we identified women (n = 1084) undergoing benign minimally invasive hysterectomy from 2009 to 2016. Multivariate logistic regression was used to examine demographic, operative, and surgeon factors associated with discharge on postoperative day 0.Results: In our study population, 238 women (22%) were discharged on the same day.Robotic hysterectomy (risk ratio [RR] 2.24; 95% confidence interval [CI] 1.13-4.44), shorter operative time (lowest quartile; RR 5.28; 95% CI 2.66-10.46), and minimal blood loss (lowest quartile; RR 3.01; 95% CI 1.68-6.23) were associated with higher same-day discharge likelihood whereas later procedure start time (2-5 pm; RR 0.38; 95% CI 0.17-0.85) and postoperative complications (RR 0.19; 95% CI 0.06-0.55) significantly decreased its likelihood. The strongest predictor was surgeon's number of years in practice, with recently graduated surgeons more likely to discharge their patients on the same day (RR 3.15; 95% CI 2.09-4.77). Conclusion:Same-day discharge after minimally invasive hysterectomy is determined by several patient, operative, and surgeon factors that can be incorporated into an implementation plan to promote earlier discharge. Most especially, scheduling patients based on perceived case complexity and targeted surgeon education can qualify a larger cohort for same-day discharge.

Factors influencing same-day discharge after minimally invasive hysterectomy for malignant and non-malignant gynecological diseases: a systematic review and meta-analysis

“…The meta-analysis showed that radical hysterectomy (OR: 3.46; 95% CI: 1.90–6.29; I 2 = 0.0%; Figure 5A ) was disadvantageous for SDD, while lymphadenectomy (OR: 1.70; 95% CI: 0.39–7.45; I 2 = 90.9%; Figure 6A ) and adhesiolysis (OR: 1.48; 95% CI: 0.91–2.41; I 2 = 56.0%; Figure 6B ) did not affect SDD ( 21 , 22 , 25 , 27 , 29 , 30 ).…”

“…There was no difference in rates of SDD between Black and White patients (OR: 1.11; 95% CI: 0.79–1.56; I 2 = 54.0%; Figure 4A ), between Hispanic and non-Hispanic people (OR: 0.66; 95% CI: 048–0.91; I 2 = 59.0%; Figure 4B ), and between smoking and non-smoking populations (OR: 1.02; 95% CI: 0.88–1.19; I 2 = 0.0%; Figure 4C ) ( 5 , 19 , 25 , 29 , 30 ).…”

“…Surgery starting after 14:00 (OR: 4.07; 95% CI: 1.36–12.17; I 2 = 90.5%; Figure 5B ) and longer surgical time (OR: 1.03; 95% CI: 1.01–1.06; I 2 = 94.2%; Figure 5C ) were disadvantageous factors for SDD ( 19 – 24 , 26 , 27 , 29 , 44 ). The end time of surgery did not affect SDD (OR: 1.14; 95% CI: 0.97–1.33; I 2 = 89.6%; Figure 6C ) ( 19 , 21 , 30 ).…”

“…Intraoperative complications (OR: 4.68; 95% CI: 1.78 to 12.27; I 2 = 74.9%; Figure 5D ) and postoperative complications (OR: 3.97; 95% CI: 1.68 to 9.39; I 2 = 0.0%; Figure 5E ) were disadvantageous factors for SDD ( 19 , 21 , 23 , 28 – 30 ). Surgeon preference was an important influencing factor for SDD (OR: 4.47; 95% CI: 2.08–9.60; I 2 = 74.6%; Figure 5F ) ( 22 , 29 ).…”

Strategies for Cost Optimization in Minimally Invasive Gynecologic Surgery

“… 40 Some factors can be modified to increase the same day discharges which eliminate the cost of the hospital stay and decrease the overall hospital costs. 41 Looking specifically at robotic hysterectomy, Borahay et al found that outpatient hysterectomy can be significantly cost-effective for the institution investing in the robotic surgery platform. 40 On a larger scale, a systematic review and meta-analysis of eight studies found that outpatient hysterectomy had a low overall re-admission and complication rate.…”