Introduction/Background The development of outpatient surgery and ERAS protocols have led to apply it to more complex oncogynecologic procedures such as hysterectomy and lymph node staging. Such an attitude implies to ensure high success rates of same-day discharge, identify possible limits and aim to improve modifiable weaknesses. The objective of this study was to evaluate the success rate of an outpatient pathway that is routinely used in our center for hysterectomy, pelvic lymphadenectomy (PLND) and paraaortic lymphadenectomy (PALND).
Methodology This retrospective study included all consecutive patients scheduled in the outpatient unit of a Comprehensive Cancer Center for a surgery including at least simple hysterectomy, PLND or PALND. The success was defined by same-day discharge and no admission in the 30 days after surgery. Multivariate logistic regression was used to determine prognostic factors associated with success. Odds ratios (OR) with 95% confidence interval (CI95) were estimated.
Results From 2015 to 2020, 232 patients were included: 22 PLND (9%), 76 PALND (33%), and 134 hysterectomies (58%). All surgeries were performed by laparoscopy, except one vaginal hysterectomy. Robotic assistance was used in 70 (30%) cases. The global outpatient success rate was 77.6% with a same-day admission rate of 15.5% and a 30-day admission rate of 7.3%. In multivariate analysis, the following factors were significantly predictive of failure: ASA score at 3 (OR, 2.74; CI95, 1.05–7.16, p=0.04), end-of-surgery time after 2 pm (OR, 4.98; CI95, 2.03–12.3; p<0.001) and operative time of more than 90 minutes (OR, 7.23; CI95, 2.10–24.8; p=0.002).
Conclusion The success rate of an outpatient strategy for hysterectomy, PLND or PALND is high when a clear outpatient pathway has been established. Preoperative identification of comorbidities, early surgery scheduling and optimization of the duration of surgery are key issues.
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