The safety of same-day discharge after laparoscopic hysterectomy for endometrial cancer

To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. Using the American College of Surgeons' National Surgical Quality Improvement Project's databa...

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Published in:	Gynecologic oncology Vol. 142; no. 3; pp. 508 - 513
Main Authors:	Lee, Jessica, Aphinyanaphongs, Yindalon, Curtin, John P., Chern, Jing-Yi, Frey, Melissa K., Boyd, Leslie R.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.09.2016
Subjects:	Ambulatory Surgical Procedures - adverse effects Ambulatory Surgical Procedures - methods Ambulatory Surgical Procedures - statistics & numerical data Endometrial cancer Endometrial Neoplasms - epidemiology Endometrial Neoplasms - surgery Female Hematology, Oncology and Palliative Medicine Hospital admission Humans Hysterectomy - adverse effects Hysterectomy - methods Hysterectomy - statistics & numerical data Laparoscopic hysterectomy Laparoscopy - adverse effects Laparoscopy - methods Laparoscopy - statistics & numerical data Middle Aged Minimally invasive Obstetrics and Gynecology Same-day discharge United States - epidemiology Endometrial cancer Laparoscopic hysterectomy Same-day discharge Hospital admission Minimally invasive
ISSN:	0090-8258, 1095-6859
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Abstract	To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes. A total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations. Rates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer. •Few patients undergo same-day discharge after laparoscopic hysterectomy for endometrial cancer in the United States.•Same day discharge patients are younger, and have fewer medical comorbidities than patients admitted to the hospital.•There was no difference in postoperative complications between same-day discharge patients and admitted patients.
AbstractList	OBJECTIVETo determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period.METHODSUsing the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes.RESULTSA total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations.CONCLUSIONSRates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer. To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes. A total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations. Rates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer. •Few patients undergo same-day discharge after laparoscopic hysterectomy for endometrial cancer in the United States.•Same day discharge patients are younger, and have fewer medical comorbidities than patients admitted to the hospital.•There was no difference in postoperative complications between same-day discharge patients and admitted patients. Abstract Objective To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. Methods Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes. Results A total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations. Conclusions Rates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer. To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge during the 30-day postoperative period. Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2014 were identified and categorized by their hospital length of stay. Statistical analyses were performed to assess the relationship between hospital stay and demographics, medical comorbidities, intraoperative surgical factors and postoperative outcomes. A total of 9020 patients had laparoscopic hysterectomies for endometrial cancer and of these, 729 patients (8.1%) were successfully discharged on the day of surgery. These patients were younger and had lower body mass indexes and fewer medical comorbidities than patients who were admitted after their procedure. The same-day discharge group underwent surgical procedures of less complexity than the hospital admission group based on shorter operative times and fewer relative value units (RVUs). There was a lower rate of surgical site infections in the same-day discharge group, and no difference in rates of other postoperative complications including hospital readmissions and reoperations. Rates of laparoscopic hysterectomy for endometrial cancer are gradually increasing but the rates of same-day discharge have increased at a much slower rate. Same-day discharge has been successful despite differences in preoperative demographics, medical comorbidities and intraoperative surgical complexity. Overall postoperative complication rates were equivalent despite length of hospital stay, demonstrating the safety and feasibility of same-day discharge after laparoscopic hysterectomy for endometrial cancer.
Author	Boyd, Leslie R. Frey, Melissa K. Lee, Jessica Chern, Jing-Yi Aphinyanaphongs, Yindalon Curtin, John P.
Author_xml	– sequence: 1 givenname: Jessica orcidid: 0000-0002-3788-5741 surname: Lee fullname: Lee, Jessica organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 2 givenname: Yindalon surname: Aphinyanaphongs fullname: Aphinyanaphongs, Yindalon organization: New York University, Center for Health Informatics and Bioinformatics, 227 East 30th Street, New York, NY, USA – sequence: 3 givenname: John P. surname: Curtin fullname: Curtin, John P. organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 4 givenname: Jing-Yi surname: Chern fullname: Chern, Jing-Yi organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 5 givenname: Melissa K. surname: Frey fullname: Frey, Melissa K. organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 6 givenname: Leslie R. surname: Boyd fullname: Boyd, Leslie R. email: Leslie.Boyd@nyumc.org organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA
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Keywords	Endometrial cancer Laparoscopic hysterectomy Same-day discharge Hospital admission Minimally invasive
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Snippet	To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day discharge... Abstract Objective To determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of... OBJECTIVETo determine factors influencing discharge patterns after laparoscopic hysterectomy for endometrial cancer and to evaluate the safety of same-day...
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SubjectTerms	Ambulatory Surgical Procedures - adverse effects Ambulatory Surgical Procedures - methods Ambulatory Surgical Procedures - statistics & numerical data Endometrial cancer Endometrial Neoplasms - epidemiology Endometrial Neoplasms - surgery Female Hematology, Oncology and Palliative Medicine Hospital admission Humans Hysterectomy - adverse effects Hysterectomy - methods Hysterectomy - statistics & numerical data Laparoscopic hysterectomy Laparoscopy - adverse effects Laparoscopy - methods Laparoscopy - statistics & numerical data Middle Aged Minimally invasive Obstetrics and Gynecology Same-day discharge United States - epidemiology
Title	The safety of same-day discharge after laparoscopic hysterectomy for endometrial cancer
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