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

• Published in: American journal of obstetrics and gynecology 2015-02, Vol.212 (2), p.186.e1-186.e8
• Main Authors: Penner, Kristine R., MD, Fleming, Nicole D., MD, Barlavi, Leah, MD, Axtell, Allison E., MD, Lentz, Scott E., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures - methods; cervical cancer; Cystoscopy - methods; endometrial cancer; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Feasibility Studies; Female; Gynecologic Surgical Procedures - methods; Humans; Hysterectomy - methods; laparoscopic staging; Laparoscopy - methods; Lymph Node Excision - methods; Lymph Nodes - pathology; Middle Aged; minimally invasive comprehensive surgical staging; Minimally Invasive Surgical Procedures - methods; Neoplasm Staging; Obstetrics and Gynecology; Ovariectomy - methods; Patient Discharge; Patient Readmission; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures - methods; robotic-assisted laparoscopic staging; Salpingectomy - methods; same-day discharge; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.08.010

Objective The objective of the study was to evaluate the feasibility and safety of same-day discharge of patients undergoing minimally invasive comprehensive surgical staging for endometrial and cervical cancer. Study Design We performed a retrospective review of consecutive patients from January 2008 to December 2011 undergoing comprehensive staging for endometrial or cervical cancer by traditional laparoscopy or robotic-assisted laparoscopy and intended for same-day discharge. Patients accomplishing same-day discharge were compared with those who required admission. Clinical and demographic data, perioperative outcomes, and postoperative patient contacts within 6 weeks were collected. Multivariate logistic regression modeling was used to determine factors associated with admission and unscheduled patient contacts within 2 weeks of surgery. Results A total of 141 patients were identified. One hundred eighteen patients (83.7%) underwent same-day discharge and 23 (16.3%) required overnight admission. The variables that significantly predicted overnight admission were severe pain in the postanesthesia care unit (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.74–26.6; P  = .006), delayed ability to tolerate oral intake (OR, 9.3; 95% CI, 2.25–38.6, P  = .002), traditional laparoscopic vs robotic-assisted surgical approach (OR, 9.05; 95% CI, 2.34–35.1; P  = .001), and surgery start time at 2:00 pm or later (OR, 36.8; 95% CI, 6.19–219.3; P < .0001). There was no difference in the readmission rate between patients undergoing same-day discharge compared with overnight admission (11% vs 17%, P  = .48). No variables significantly predicted unscheduled patient contact within 2 weeks of surgery at P  < .01. Conclusion Same-day discharge for patients undergoing laparoscopic or robotic-assisted laparoscopic staging for endometrial or cervical cancer is feasible and safe. There are low complication rates and few readmissions or unscheduled patient contacts within 2 weeks of surgery.