Jessica Lee1, Yindalon Aphinyanaphongs2, John P Curtin1, Jing-Yi Chern1, Melissa K Frey1, Leslie R Boyd3. 1. New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA. 2. New York University, Center for Health Informatics and Bioinformatics, 227 East 30th Street, New York, NY, USA. 3. New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA. Electronic address: Leslie.Boyd@nyumc.org.
Abstract
OBJECTIVE: To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. METHODS: Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes. RESULTS: A total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations. CONCLUSIONS: Rates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer.
OBJECTIVE: To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. METHODS: Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes. RESULTS: A total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations. CONCLUSIONS: Rates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer.
Authors: Margaret I Liang; Emeline M Aviki; Jason D Wright; Laura J Havrilesky; Leslie R Boyd; Haley A Moss; Elizabeth L Jewell; David E Cohn; Sachin M Apte; Patrick F Timmins; Ronald D Alvarez; Jill Rathbun; Elizabeth Lipinski; Susan White; Dorimar Siverio-Minardi; Emily M Ko Journal: Gynecol Oncol Date: 2020-01-06 Impact factor: 5.482
Authors: Alexander L Colonna; Brandon K Bellows; Toby M Enniss; Jason B Young; Marta McCrum; Jade M Nunez; Raminder Nirula; Richard E Nelson Journal: Surg Open Sci Date: 2020-01-23