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Original research
Avoidable admissions after minimally invasive hysterectomy
  1. Amanda Manorot1,
  2. Shitanshu Uppal1,
  3. Olivia de Bear1,
  4. Cynthia Stroup1,
  5. Liam Dalton2,
  6. Aimee Rolston1,
  7. Kevin McCool3,
  8. R Kevin Reynolds1,
  9. Karen McLean4,
  10. Jean Siedel1 and
  11. Alli M Straubhar1
    1. 1 Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
    2. 2 University of Michigan Medical School, Ann Arbor, Michigan, USA
    3. 3 Beaumont Health System, Royal Oak, Michigan, USA
    4. 4 Roswell Park Cancer Institute, Buffalo, New York, USA
    1. Correspondence to Dr Alli M Straubhar, Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA; astraubhar{at}gmail.com

    Abstract

    Objective To determine the rate of avoidable admissions following anticipated same-day discharge for patients undergoing minimally invasive hysterectomy and to identify risk factors associated with such admissions.

    Methods A retrospective review was performed of patients who underwent a minimally invasive hysterectomy between March 2019 and July 2021 for a suspected gynecologic malignancy at a single tertiary care center. Pre-operatively, patients were assessed for same-day discharge versus planned admission. Reasons for day-of-surgery admission despite anticipated same-day discharge were categorized as anesthesia-related, system issues, intra-operative factors, post-operative pain, and social factors. Patients deemed not candidates for same-day discharge were defined as planned admissions. Indications were categorized as necessary or potentially avoidable. Descriptive and comparative statistics were used to summarize the cohort.

    Results In total, 372 patients were identified: 261 (70.2%) anticipated same-day discharges and 111 (29.8%) planned admissions. Of anticipated same-day discharges, 230/261 (88.1%) were successfully discharged, while 31/261 (11.9%) required admission. Reasons for unplanned admissions were anesthesia-related (14/31, 45.2%), system issues (7/31, 22.6%), intra-operative factors (5/31, 16.1%), post-operative pain (3/31, 9.7%), and social factors (2/31, 6.5%). Among the 111 pre-operatively planned admissions, 81 (73.0%) were necessary due to comorbidities or surgical complexity, while 30 (27.0%) were potentially avoidable because patients could have been optimized for same-day discharge. Opportunities for optimization pre-operatively included comorbidities (13/30, 43.3%), system issues (8/30, 26.7%), social factors (6/30, 20.0%), and provider preference (3/30, 10.0%).

    Conclusion Most patients undergoing minimally invasive hysterectomy can be safely discharged the same day. Potentially avoidable admissions were primarily related to patient comorbidities that can be better optimized pre-operatively.

    • Hysterectomy

    Data availability statement

    Data are available upon reasonable request. Requests should be made to the corresponding author.

    https://doi.org/10.1136/ijgc-2024-005391

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      Data availability statement

      Data are available upon reasonable request. Requests should be made to the corresponding author.

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      Footnotes

      • Presented at This research was presented as a poster at the Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, March 18–22, 2022, Phoenix, AZ.

      • Contributors AM: Conceptualization, data curation, formal analysis, writing – original draft, writing – review and editing. SU: Conceptualization, formal analysis, writing – review and editing. OdB: Conceptualization, data curation, formal analysis, writing – review and editing. CS: Conceptualization, data curation, formal analysis, writing – review and editing. LD: Conceptualization, formal analysis, writing – review and editing. AR: Conceptualization, formal analysis, writing – review and editing. KM: Conceptualization, formal analysis, writing – review and editing. RKR: Conceptualization, formal analysis, writing – review and editing. KM: Conceptualization, formal analysis, writing – review and editing. JS: Conceptualization, formal analysis, writing – review and editing. AMS: Conceptualization, data curation; formal analysis, writing – original draft, writing – review and editing, guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

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

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.