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

Abdelrahman AlAshqar 1 2, Brian Wildey 1, Golsa Yazdy 1, Metin E Goktepe 3, Gokhan S Kilic 4, Mostafa A Borahay 1

Affiliations

01 August 2022

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doi: 10.1002/ijgo.13992

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.

Keywords: minimally invasive hysterectomy; operative time; same-day discharge; surgeon experience.

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References

  1.  
    1. Lee J, Jennings K, Borahay MA, et al. Trends in the national distribution of laparoscopic hysterectomies from 2003 to 2010. J Minim Invasive Gynecol. 2014;21(4):656-661. 10.1016/j.jmig.2014.01.012
  2.  
    1. Smith AJB, AlAshqar A, Chaves KF, Borahay MA. Association of demographic, clinical, and hospital-related factors with use of robotic hysterectomy for benign indications: a national database study. Int J Med Robot. 2020;16(4):e2107. 10.1002/rcs.2107
  3.  
    1. Krell RW, Girotti ME, Dimick JB. Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA Surg. 2014;149(8):815-820. 10.1001/jamasurg.2014.629
  4.  
    1. AlAshqar A, Goktepe ME, Kilic GS, Borahay MA. Predictors of the cost of hysterectomy for benign indications. J Gynecol Obstet Hum Reprod. 2021;50(2):101936. 10.1016/j.jogoh.2020.101936
  5.  
    1. Jennings AJ, Spencer RJ, Medlin E, Rice LW, Uppal S. Predictors of 30-day readmission and impact of same-day discharge in laparoscopic hysterectomy. Am J Obstet Gynecol. 2015;213(3):344.e1-344.e7. 10.1016/j.ajog.2015.05.014
  6.  
    1. Bruneau L, Randet M, Evrard S, Damon A, Laurent FX. Total laparoscopic hysterectomy and same-day discharge: Satisfaction evaluation and feasibility study. J Gynecol Obstet Biol Reprod (Paris). 2015;44(9):870-876. 10.1016/j.jgyn.2015.02.003
  7.  
    1. Korsholm M, Mogensen O, Jeppesen MM, Lysdal VK, Traen K, Jensen PT. Systematic review of same-day discharge after minimally invasive hysterectomy. Int J Gynaecol Obstet. 2017;136(2):128-137. 10.1002/ijgo.12023
  8.  
    1. Borahay MA, Patel PR, Kilic CH, Kilic GS. Outpatient robotic hysterectomy: clinical outcomes and financial analysis of initial experience. Int J Med Robot. 2014;10(2):244-250. 10.1002/rcs.1565
  9.  
    1. Schiavone MB, Herzog TJ, Ananth CV, et al. Feasibility and economic impact of same-day discharge for women who undergo laparoscopic hysterectomy. Am J Obstet Gynecol. 2012;207(5):382.e1-382.e9. 10.1016/j.ajog.2012.09.014
  10.  
    1. Zeybek B, Oge T, Kilic CH, Borahay MA, Kilic GS. A financial analysis of operating room charges for robot-assisted gynaecologic surgery: Efficiency strategies in the operating room for reducing the costs. J Turk Ger Gynecol Assoc. 2014;15(1):25-29. 10.5152/jtgga.jtgga.2014.79989
  11.  
    1. Sheyn D, El-Nashar S, Billow M, Mahajan S, Duarte M, Pollard R. Readmission rates after same-day discharge compared with postoperative day 1 discharge after benign laparoscopic hysterectomy. J Minim Invasive Gynecol. 2018;25(3):484-490. 10.1016/j.jmig.2017.10.013
  12.  
    1. Praiss AM, Chen L, St Clair CM, et al. Safety of same-day discharge for minimally invasive hysterectomy for endometrial cancer. Am J Obstet Gynecol. 2019;221(3):239.e1-239.e11. 10.1016/j.ajog.2019.05.003
  13.  
    1. Lee SJ, Calderon B, Gardner GJ, et al. The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications. Gynecol Oncol. 2014;133(3):552-555. 10.1016/j.ygyno.2014.04.006
  14.  
    1. Penner KR, Fleming ND, Barlavi L, Axtell AE, Lentz SE. Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies. Am J Obstet Gynecol. 2015;212(2):186.e1-186.e8. 10.1016/j.ajog.2014.08.010
  15.  
    1. Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg. 1999;230(2):251-259. 10.1097/00000658-199908000-00016
  16.  
    1. Cheng H, Clymer JW, Po-Han Chen B, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134-144. 10.1016/j.jss.2018.03.022
  17.  
    1. English EM, Bell S, Kamdar NS, Swenson CW, Wiese H, Morgan DM. Importance of estimated blood loss in resource utilization and complications of hysterectomy for benign indications. Obstet Gynecol. 2019;133(4):650-657. 10.1097/AOG.0000000000003182
  18.  
    1. Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320-330. 10.1097/00000658-199809000-00005
  19.  
    1. Stovall TG, Summitt RL Jr, Bran DF, Ling FW. Outpatient vaginal hysterectomy: a pilot study. Obstet Gynecol. 1992;80(1):145-149.
  20.  
    1. Lee L, Weston W. The aging physician. Can Fam Physician. 2012;58(1):17-18.
  21.  
    1. Rajpal S, Shah M, Vivek N, Burneikiene S. Analyzing the correlation between surgeon experience and patient length of hospital stay. Cureus. 2020;12(8):e10099. 10.7759/cureus.10099
  22.  
    1. Satkunasivam R, Klaassen Z, Ravi B, et al. Relation between surgeon age and postoperative outcomes: a population-based cohort study. CMAJ. 2020;192(15):E385-E392. 10.1503/cmaj.190820
  23.  
    1. Kilic GS, Moore G, Elbatanony A, Radecki C, Phelps JY, Borahay MA. Comparison of perioperative outcomes of total laparoscopic and robotically assisted hysterectomy for benign pathology during introduction of a robotic program. Obstet Gynecol Int. 2011;2011: :1-8. 10.1155/2011/683703
  24.  
    1. Asoglu MR, Achjian T, Akbilgic O, Borahay MA, Kilic GS. The impact of a simulation-based training lab on outcomes of hysterectomy. J Turk Ger Gynecol Assoc. 2016;17(2):60-64. 10.5152/jtgga.2016.16053
  25.  
    1. Borahay MA, Haver MC, Eastham B, Patel PR, Kilic GS. Modular comparison of laparoscopic and robotic simulation platforms in residency training: a randomized trial. J Minim Invasive Gynecol. 2013;20(6):871-879. 10.1016/j.jmig.2013.06.005
  26.  
    1. Gien LT, Kupets R, Covens A. Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology. Gynecol Oncol. 2011;121(2):339-343. 10.1016/j.ygyno.2010.12.344
  27.  
    1. Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol. 2008;111(5):1155-1160. 10.1097/AOG.0b013e31816e34b4
  28.  
    1. Husslein H, Franz M, Gutschi M, Worda C, Polterauer S, Leipold H. Postoperative gum chewing after gynecologic laparoscopic surgery: a randomized controlled trial. Obstet Gynecol. 2013;122(1):85-90. 10.1097/AOG.0b013e3182983e92
  29.  
    1. Nowakowski S, Levy-Meeks ME, Dawson DB, et al. Association of preoperative sleep pattern with posthysterectomy pain: a pilot study. J Clin Sleep Med. 2020;16(11):1901-1908. 10.5664/jcsm.8730
  30.  
    1. Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg. 1999;88(3):508-517. 10.1097/00000539-199903000-00008
  31.  
    1. Perron-Burdick M, Yamamoto M, Zaritsky E. Same-day discharge after laparoscopic hysterectomy. Obstet Gynecol. 2011;117(5):1136-1141. 10.1097/AOG.0b013e318215dd4e
  32.  
    1. ACOG Committee opinion no. 750 summary: perioperative pathways: enhanced recovery after surgery. Obstet Gynecol. 2018;132(3):801-802. 10.1097/AOG.0000000000002819
  33.  
    1. Morgan M, Beech R. Variations in lengths of stay and rates of day case surgery: implications for the efficiency of surgical management. J Epidemiol Community Health. 1990;44(2):90-105. 10.1136/jech.44.2.90
  34.  
    1. Fountain CR, Havrilesky LJ. Promoting same-day discharge for gynecologic oncology patients in minimally invasive hysterectomy. J Minim Invasive Gynecol. 2017;24(6):932-939. 10.1016/j.jmig.2017.05.005

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