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OP025/#128 Comprehensive perioperative care program to improve same-day discharge after minimally invasive gynecologic oncology surgery
  1. RS Kim1,
  2. S Laframboise1,
  3. G Nelson2,
  4. S Mccluskey3,
  5. L Avery4,
  6. N Kujbid1,
  7. A Zia1,
  8. M Bernardini1,
  9. S Ferguson1,
  10. T May1,
  11. L Hogen1,
  12. P Cybulska1 and
  13. G Bouchard-Fortier1
  1. 1Princess Margaret Cancer Centre/University of Health Network/Sinai Health Systems, Gynecologic Oncology, Toronto, Canada
  2. 2Cumming School of Medicine, Obstetrics and Gynecology, Calgary, Canada
  3. 3Toronto General Hospital, University Health Network, Anesthesia and Pain Management, Toronto, Canada
  4. 4Princess Margaret Cancer Centre, Biostatistics, Toronto, Canada


Objectives Same-day discharge (SDD) after minimally invasive hysterectomy for gynecologic conditions has been shown to be safe and feasible. We designed and implemented a quality improvement perioperative program to improve SDD rate from 30% to 75% over a 12-month period.

Methods We included 102 consecutive patients undergoing minimally invasive hysterectomy at a single cancer centre during the 12-month implementation period. A pre-intervention cohort of 100 patients was identified for comparison of clinicodemographic variables and perioperative outcomes. We developed a comprehensive perioperative care program based on Early Recovery after Surgery (ERAS) principles and met bi-weekly for plan-do-study-act (PDSA) cycles. Patients were followed for 30 days after discharge. We used a run chart to monitor the effects of our interventions and conducted a multivariate analysis to determine patient factors or interventions associated with SDD.

Results SDD rate increased from 29% to 75% after implementation (p<0.001). The post implementation cohort was significantly younger (59 vs. 65yrs; p=0.025) and had shorter operative times (180 vs. 211 minutes; p<0.001) but the two groups were similar in BMI, comorbidity, stage, and intraoperative complications. There was no difference in 30-day perioperative complications, readmissions, reoperations, emergency department visits, or mortality. The most common reason for overnight admission post intervention was nausea and vomiting (16%). Overall, 89% of patients rated their experience as ‘very good’ or ‘excellent’, and 87% felt that their post-operative length of stay was adequate.

Conclusions Following implementation of a perioperative quality improvement program, our interventions significantly improved SDD rates while maintaining low 30-day perioperative complications and excellent patient experience.

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