Can We Predict Same Day Discharge after Minimally Invasive Hysterectomy

Study Objective There has been increasing encouragement for same day discharge after minimally invasive hysterectomy; however, clear predictors of same day discharge have not been established. This study aims to analyze preoperative characteristics and peri-operative outcomes, for patients undergoing minimally invasive hysterectomy, who were discharged on postoperative day zero. We compare them to characteristics of patients discharged home on postoperative day one or more. Design Retrospective chart review. Setting University-affiliated hospital. Patients or Participants Patients undergoing minimally invasive hysterectomy between 2017-2019. Interventions N/A Measurements and Main Results Two hundred and five patients were included in this study; 23% of patients were discharged on postoperative day zero (SDD group), while 77% were admitted to the hospital. Discharged patients were all under 70 years of age. The median age for the SDD group was 50 vs 55 for the admitted group (p value 0.002). History of abdominal surgery or hypertensive disorder was more common in patients discharged postoperative day one or greater (p 0.004 and 0.003, respectively). Intraoperative and postoperative complications were associated with 100% admission rates (p 0.0084). No difference was found in BMI, EBL, starting hemoglobin, uterus weight and operation duration between the two groups. No difference was found in admission rates regarding diabetes, COPD or smoking status. This analysis found no statistically significant difference in readmission rates, when adjusted for age, with an odds ratio of 2.4 (CI 0.30-20.2) Conclusion Hypertension and previous abdominal surgery increase the risk of perioperative complications, which may act as a confounding factor in this study. Age and surgical complications were the only factors found to be independent predictors of admission. Readmission rates were similar. Same day discharge is a safe, practical disposition for majority of patients, and further randomized trials are warranted.