Factors Associated with Prolonged Ambulatory Surgery Stay for Major Gynecologic Surgery

Study Objective To identify factors associated with overnight admission after major minimally invasive gynecologic surgery, and create a prediction model. Design Retrospective cohort study. Setting Academic Medical Center. Patients or Participants Patients undergoing major minimally invasive surgery by a single surgeon between 2018 and 2020. Interventions Pre-operative patient characteristic data and peri-operative data were collected retrospectively. Logistic regression analysis of factors associated with same-day discharge versus overnight admission was performed. Measurements and Main Results 461 major minimally invasive cases were identified, of which 425 cases were considered eligible for ambulatory surgery discharge and were included in the analysis. 279 (65.6%) patients were discharged same-day, and 146 (34.4%) were admitted.Patients with later procedure start times (OR 0.9), cancer pathology (OR 0.4), high four-hour postoperative pain scores (OR 0.8), and presence of urinary catheter in the recovery room (OR 0.1) had significantly decreased likelihood of same-day discharge. A prediction model including nineteen patient characteristic and peri-operative variables explained 57.8% of the variability of whether or not patients were admitted after surgery. The model correctly predicted 69.3% of admissions and 90.1% of same-day discharges, giving an overall prediction rate of 82.4%. 7 (2.5%) patients discharged same-day and 4 (2.7%) patients admitted returned to the emergency room within 30 days; 1 (0.4%) patient discharged same-day and 4 (2.7%) patients admitted had a readmission within 30 days. Conclusion Peri-operative factors such as surgery start time, postoperative pain level, presence of urinary catheter in the recovery room as well as diagnosis of malignancy are predictive of overnight admission. Postoperative hospital stay does not improve 30-day readmission rates or the number of ER visits after the discharge. Knowledge of factors associated with prolonged stay after major ambulatory surgery can aid in counseling and peri-operative planning.