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Am J Obstet Gynecol. 2019 May 10. pii: S0002-9378(19)30658-1. doi: 10.1016/j.ajog.2019.05.003. [Epub ahead of print]

Safety of Same Day Discharge for Minimally Invasive Hysterectomy for Endometrial Cancer.

Author information

1
Columbia University Vagelos College of Physicians and Surgeons; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center.
2
Columbia University Vagelos College of Physicians and Surgeons.
3
Columbia University Vagelos College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center.
4
Columbia University Vagelos College of Physicians and Surgeons; Joseph L. Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center.
5
Joseph L. Mailman School of Public Health, Columbia University; Rutgers Robert Wood Johnson Medical School; Environmental and Occupational Health Sciences Institute.
6
Columbia University Vagelos College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center. Electronic address: jw2459@columbia.edu.

Abstract

BACKGROUND:

Same day discharge is becoming increasingly common for women who undergo minimally invasive hysterectomy. For women with endometrial cancer, there is limited data to describe the safety of same day discharge.

OBJECTIVE:

To examine trends and outcomes of same day discharge for women with endometrial cancer who underwent minimally invasive hysterectomy.

STUDY DESIGN:

The National Surgical Quality Improvement Program database was used to identify patients who underwent MIS hysterectomy based for endometrial cancer from 2011-2016. The cohort was limited to women discharged on the day of surgery/postoperative day 0 or postoperative day 1. Multivariable models were used to examine clinical, demographic, and procedural characteristics associated with discharge on postoperative day 0. Multivariable models were also developed to examine the association between same day discharge and readmission.

RESULTS:

A total of 17,935 patients who underwent minimally invasive hysterectomy were identified. Of those discharged within 1 day, 1,828 (12.4%) were discharged on postoperative day 0 and 12,892 (87.6%) were discharged on postoperative day 1 or after. The rate of same day discharge rose from 5.6% in 2011 to 16.3% in 2016 (P<0.001). In a multivariable model, more recent year of surgery was associated with same day discharge while older age (≥70 years old), chronic obstructive pulmonary disease, and hypertension were associated with a decreased likelihood of same day discharge. Similarly, obese women were 15% less likely to have a same day discharge than normal weight women (rate ratio=0.85; 95% confidence interval, 0.75-0.97). Hispanic women (rate ratio=1.61; 95% confidence interval, 1.35-1.92 compared to white women) and those who underwent lymphadenectomy (rate ratio=1.17; 95% confidence interval, 1.07-1.29) were more likely to have a same day discharge. The readmission rate was 2.3% in those women discharged on the day of surgery compared to 3.1% in women discharged on postoperative day 1 (P=0.051). In a multivariable model there was no association between same day discharge and readmission (rate ratio=0.99; 95% confidence interval, 0.71-1.38). Among women discharged on the day of surgery, a longer operative time and the occurrence of a perioperative complication were associated with readmission.

CONCLUSION:

Same day discharge for minimally invasive hysterectomy for endometrial cancer is increasing. In selected patients there is no increased risk of readmission with same day discharge.

KEYWORDS:

discharge; endometrial cancer; hysterectomy; readmission; same day

PMID:
31082381
DOI:
10.1016/j.ajog.2019.05.003

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