Original Article
Factors Influencing Same-day Hospital Discharge and Risk Factors for Readmission After Robotic Surgery in the Gynecologic Oncology Patient Population

https://doi.org/10.1016/j.jmig.2014.10.001Get rights and content

Abstract

Study Objective

To determine the factors that allow for a safe outpatient robotic-assisted minimally invasive gynecologic oncology surgery procedure.

Design

Retrospective chart review (Canadian Task Force classification II-1).

Setting

University hospital.

Patients

All patients (140) undergoing robotic-assisted minimally invasive surgery with the gynecologic oncology service from January 1, 2013, to December 31, 2013.

Interventions

Risk factors for unsuccessful discharge within 23 hours of surgery and same-day discharge were assessed using logistic regression models.

Measurements and Main Results

All patients were initially scheduled for same-day discharge. The outpatient surgery group was defined by discharge within 23 hours of the surgery end time, and a same-day surgery subgroup was defined by discharge before midnight on the day of surgery. One hundred fifteen (82.1%) were successfully discharged within 23 hours of surgery, and 90 (64.3%) were discharged the same day. The median hospital stay was 5.3 hours (range, 1–48 hours). Unsuccessful discharge within 23 hours was associated with a preoperative diagnosis of lung disease and intraoperative complications; unsuccessful same-day discharge was associated with older age and later surgery end time. Only 2 patients (1.4%) were readmitted to the hospital within 30 days of surgery.

Conclusions

Outpatient robotic-assisted minimally invasive surgery is safe and feasible for most gynecologic oncology patients and appears to have a low readmission rate. Older age, preoperative lung disease, and later surgical end time were risk factors for prolonged hospital stay. These patients may benefit from preoperative measures to facilitate earlier discharge.

Section snippets

Study Population

University of Minnesota Institutional Review Board approval was obtained for this study. All robotic hysterectomies performed at the University of Minnesota Medical Center by the gynecologic oncology faculty were identified through a query of the gynecologic oncology surgical database. A retrospective chart review of all patients undergoing a robotic hysterectomy between January 1, 2013, and December 31, 2013, was performed. Patients were excluded from analysis if there was preoperative

Results

A total of 191 surgical records were reviewed. Of those, 38 subjects were excluded before complete chart review because of cancellation of surgery (n = 17), conversion to laparotomy (n = 19), or surgery performed in conjunction with another surgical service (n = 2). After EHR review, an additional 13 subjects were excluded because of preoperative documentation of a planned postoperative admission. One hundred forty patients were included in the final analysis (Fig. 1). The mean age at surgery

Discussion

Our study supports the safety and feasibility of same-day hospital discharge in gynecologic oncology patients undergoing robotic surgery. We evaluated both discharge within 23 hours and discharge before midnight on the day of surgery. We identified age, preexisting lung pathology, intraoperative complications, and surgery end time as potential risk factors for longer hospital stays. Same-day discharge after minimally invasive surgery is becoming increasingly popular because of the increasing

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The authors declare no conflict of interest.

Supported by National Institutes of Health grant P30 CA77598 using the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114.

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