Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies

Same-Day Discharge After Laparoscopic Hysterectomy for Endometrial Cancer

“…These data did not allow for ascertainment of which patients were scheduled for SDD prior to surgery but ultimately required admission, a subject that has been the focus of other studies investigating the safety and feasibility of SDD. 21,22 The relatively low rates of PLND and PALND in this study reflect our institutional practice of foregoing lymphadenectomy when preoperative and intraoperative frozen-section analysis are consistent with lowrisk endometrial cancer, [4][5][6]35,36 and may limit the generalizability of our findings to centers with similar practice patterns. A further limitation of this study is the absence of patient-reported outcomes.…”

“…19 More recently, Penner and colleagues found that SDD was feasible and safe in a series of 141 patients undergoing comprehensive staging for endometrial or cervical cancer. 21 Among 200 patients scheduled for robotic-assisted laparoscopic hysterectomy for a mixture of benign and malignant indications, Lee and colleagues found that 78 % of patients could be discharged home on the day of surgery, with acceptable rates of urgent care visits and readmission. 22 Our study is subject to several limitations.…”

“…Several retrospective studies have suggested that despite older age and higher rates of comorbidities, perioperative morbidity and readmission rates after SDD are acceptably low in patients undergoing laparoscopic management of gynecologic cancers. [19][20][21][22] Gynecologic oncologists in our institution began implementing SDD for patients undergoing laparoscopic hysterectomy for endometrial cancer and EIN in 2011. In collaboration with a dedicated anesthesiologist, perioperative care protocols favoring SDD were developed, resulting in the broad adoption of SDD for patients undergoing laparoscopic management of these conditions.…”

Predictors of 30-day readmission and impact of same-day discharge in laparoscopic hysterectomy

“…The time of surgery is not recorded in NSQIP, a factor that influences the same-day discharge significantly. 17 In addition, the NSQIP database does not allow the analysis of surgical volume because of deidentification of the contributing hospital. Higher readmission rates have been implicated to low-volume centers.…”

Predicting Inpatient Stay Lasting 2 Midnights or Longer After Robotic Surgery for Endometrial Cancer

“…Avoidance of unnecessary inpatient stays after robotic surgery will help take advantage of the cost savings obtained from decreased length of stay compared with laparotomy. Since 2010, there has been a trend toward the institution of rapid recovery protocols in gynecologic surgery, and even reports of the safe and feasible same-day discharge of patients undergoing minimally invasive surgical staging for gynecologic malignancy [13,14]. As the surgical landscape continues to evolve, our reported data also provide further impetus for continued collection of data on factors predicting inpatient stay after robotic surgery and prospective analysis of strategies to reduce the length of stay for these patients, particularly those with risk factors.…”