Introduction Same-day discharge (SDD) in patients undergoing minimally invasive gynecologic oncology surgery (MIGOS) is a recent trend aligned with Enhanced Recovery After Surgery (ERAS) principles. SDD in MIGOS has been shown to be safe and feasible based on several recent studies. A baseline audit at our institution found the SDD rate in MIGOS to be 14%. To address this, we initiated an ERAS quality improvement (QI) project with the goal to increase the SDD rate in MIGOS >75%.

Methods Four interventions were designed to address root causes identified for failed SDD following QI diagnostics: 1) SDD as the default discharge plan, 2) ‘Day Surgery’ surgical booking, 3) development and implementation of an ERAS SDD order set, and 4) patient education SDD documents. A pre/post-intervention design was used (50 patients per group) and rate of SDD was measured together with patient demographics and surgical outcomes. Process and balancing measures were defined and tracked.

Results SDD in MIGOS increased from 14% to 82% after the implementation of the above interventions (OR 28, p<0.0001, 95%CI 9.54–82.11). Improved SDD was achieved without negatively impacting postoperative rates of emergency department visits: 8% pre-, 4% post-intervention within 7 days (OR 0.48, p=0.678, 95%CI 0.09–2.74), 12% pre-, 10% post-intervention within 30 days (OR 0.8148, p=1.0, 95% CI 0.2317–2.86).

Conclusion/Implications An ERAS QI initiative resulted in a substantial increase in SDD in MIGOS, without causing negative impacts on defined balancing measures.