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Sustainability of an enhanced recovery pathway after minimally invasive gynecologic oncology surgery
  1. Anna McCracken1,
  2. Rachel Soyoun Kim1,2,
  3. Stephane Laframboise1,2,
  4. Manjula Maganti3,
  5. Marcus Q Bernardini1,2,
  6. Sarah Ferguson1,2,
  7. Liat Hogen1,2,
  8. Taymaa May1,2,
  9. Stuart A McCluskey4 and
  10. Geneviève Bouchard-Fortier1,2
    1. 1 University Health Network, Toronto, Ontario, Canada
    2. 2 Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
    3. 3 Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
    4. 4 Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
    1. Correspondence to Dr Geneviève Bouchard-Fortier, Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2C4, Canada; genevieve.bouchard-fortier{at}


    Objective Same day discharge is safe after minimally invasive gynecology oncology surgery. Our quality improvement peri-operative program based on enhanced recovery after surgery principles led to an increase in same day discharge from 30% to 75% over a 12 month period. Twelve months after program implementation, we assessed the sustainability of same day discharge rates, determined post-operative complication rates, and evaluated factors affecting same day discharge rates.

    Methods A retrospective chart review was conducted of 100 consecutive patients who underwent minimally invasive surgery at an academic cancer center from January to 2021 to December 2021. This cohort was compared with the active intervention cohort (n=102) from the implementation period (January 2020 to December 2020). Same day discharge rates and complications were compared. Multivariable analysis was performed to assess which factors remained associated with same day discharge post-intervention.

    Results Same day discharge post-intervention was 72% compared with 75% during active intervention (p=0.69). Both cohorts were similar in age (p=0.24) and body mass index (p=0.27), but the post-intervention cohort had longer operative times (p=0.001). There were no significant differences in 30-day complications, readmission, reoperation, or emergency room visits (p>0.05). There was a decrease in 30-day post-operative clinic visits from 18% to 5% in the post-intervention cohort (p=0.007), and unnecessary bowel prep use decreased from 35% to 14% (p<0.001). On multivariable analysis, start time (second case of the day) (OR 0.06; 95% CI 0.01 to 0.35), and ward narcotic use (OR 0.12; 95% CI 0.03 to 0.42) remained associated with overnight admission.

    Conclusion Same day discharge rate was sustained at 72%, 12 months after the implementation of a quality improvement program to optimize same day discharge rate after minimally invasive surgery, while maintaining low post-operative complications and reducing unplanned clinic visits. To maximize same day discharge, minimally invasive gynecologic oncology surgery should be prioritized as the first case of the day, and post-operative narcotic use should be limited.

    • Postoperative Period
    • Preoperative Period
    • Cervical Cancer
    • Uterine Cancer

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • Contributors AMC: data curation, formal analysis, writing—original draft, writing—review, and editing. RSK: data curation, conceptualization, writing—review, and editing. SL: conceptualization, funding acquisition, project administration, datacuration, investigation, methodology, writing—review, and editing. MM: resources, writing—review, and editing. MQB: resources, writing—review, and editing. SEF: resources, writing—review, and editing. LH: resources, writing—review, and editing. TM: resources, writing—review, and editing. SAMC: resources, writing—review, and editing. GB-F: Guarantor, conceptualization, formal analysis, funding acquisition, project administration, investigation, methodology, supervision, writing—review, and editing.

    • Funding The project was supported by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centers of Ontario (MSU 19-019); the funding source had no involvement in the conduct of the research, study design, or preparation of this article.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.