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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