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Original research
Predictors and outcomes of same day discharge after minimally invasive hysterectomy in gynecologic oncology within the National Surgical Quality Improvement Program database
  1. Tal Milman1,
  2. Azusa Maeda2,
  3. Brenna E Swift1,3 and
  4. Geneviève Bouchard-Fortier1,2
  1. 1Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
  3. 3Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Geneviève Bouchard-Fortier, University Health Network, Toronto, Ontario, M5G 2C4, Canada; genevieve.bouchard-fortier{at}uhn.ca

Abstract

Objective To assess trends over time of same day discharge after minimally invasive hysterectomy in oncology, identify perioperative factors influencing same day discharge, and evaluate 30 day postoperative morbidity.

Methods A retrospective cohort of elective minimally invasive hysterectomies performed for gynecologic oncologic indications between January 2013 and December 2021 was identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Clinical and surgical characteristics, length of stay, and 30 day postoperative complications were captured. Clinical and surgical factors affecting same day discharge rate and impact of same day discharge on postoperative outcomes were evaluated using χ2 tests and logistic regression.

Results Patients undergoing minimally invasive hysterectomy (n=32 823) had a same day discharge rate of 34.5% over the 9 year period, increasing from 15.5% in 2013 to 55.1% in 2021. The rate of patients discharged on postoperative day 1 decreased from 76.4% to 41.4% over this period. On multivariable analysis, same day discharge decreased with: age 70–79 years (odds ratio (OR) 0.80) and ≥80 years (OR 0.42); body mass index 40–49.9 kg/m2 (OR 0.89) and ≥50 kg/m2 (OR 0.67); patient comorbidities, including hypertension (OR 0.85), chronic steroid use (OR 0.74), bleeding disorder (OR 0.54), anemia (OR 0.89), and hypoalbuminemia (OR 0.76); and surgical time >90th percentile (OR 0.40) (all p<0.05). Lymphadenectomy did not impact the same day discharge rate (unadjusted OR 1.03, p=0.22). Same day discharge had no effect on 30 day postoperative composite morbidity (OR 0.91, p=0.20), and was associated with fewer readmissions (OR 0.75, p=0.005). Age 70–79 years (OR 1.07, p=0.435) and age ≥80 years (OR 1.11, p=0.504) did not increase postoperative morbidity. However, body mass index categories 40–49.9 kg/m2 (OR 1.28, 95% CI 1.08 to 1.51) and ≥50 kg/m2 (OR 1.60, 95% CI 1.27 to 2.01) were associated with greater 30 day composite morbidity.

Conclusion In this study, same day discharge following minimally invasive hysterectomy for oncologic indications was safe, and rates are rising among all age and body mass index categories. Quality improvement initiatives are needed at oncology centers to promote early discharge after minimally invasive gynecologic oncology surgery.

  • Hysterectomy
  • Gynecologic Surgical Procedures
  • Genital Neoplasms, Female
  • Postoperative complications
  • Postoperative Care

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons National Surgical Quality Improvement Program.

https://doi.org/10.1136/ijgc-2023-004970

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons National Surgical Quality Improvement Program.

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    Footnotes

    • Twitter @BE_Swift7

    • Contributors TM: conceptualization, investigation, methodology, drafting and figures, writing (original draft and editing), guarantor. AM: conceptualization, data collection, statistical analysis, drafting and figures. BES: conceptualization, supervision, writing (review and editing). GBF: conceptualization, investigation, methodology, project administration, supervision, writing (review and editing).

    • 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.