Abstract
To identify risk factors for inpatient admission after laparoscopic and robot-assisted myomectomy to improve preoperative counseling and postoperative care. Retrospective cohort study including patients undergoing minimally invasive myomectomy from January 2014 to December 2016 at an urban university hospital center by fellowship trained minimally invasive gynecologic surgeons (N = 249). All pre-operative and operative characteristics were collected. Similarly, all intraoperative and postoperative complications were gathered for analysis. T-test was used to compare characteristics of cases with overnight stay versus cases with same day discharge. Logistic regression analysis was performed to ascertain further clinical predictors of overnight stay. Two hundred forty-nine patients underwent minimally invasive myomectomies. One hundred twenty (48%) were admitted for at least one overnight stay while 129 (52%) were discharged the same day. Overnight stay compared to same day discharge was associated significantly with older age (38 vs. 35 years, P < 0.001), lower pre-op hematocrit (36% vs. 38%, P = 0.007), and prior surgical procedure including prior cesarean section (12% vs. 2%, P = 0.005) or myomectomy (12% vs. 5%, P = 0.049), single site procedures (30% vs. 10.1%, P < 0.001), prolonged operative time (185 vs. 139 minutes, P < 0.001), and intraoperative or post-operative complication including blood loss >1,000 mL (7.5% vs. 0%, P = 0.001). Logistic regression analysis found that 5% decrease in Hematocrit, single site operation, 30 minute increase in operative time are significant predictors of any inpatient admission after myomectomy. Perioperative factors such as preoperative hematocrit, and modality of minimally invasive surgery as well as intraoperative factors such as prolonged operative time are predictive of overnight hospital stay. That information could be used for better patient optimization preoperatively and improved counseling.
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