Factors influencing length of stay following minimally invasive laparoscopic hysterectomy

Abstract

Minimally invasive hysterectomy (MIH) for benign and malignant conditions allows for shorter hospital stays. We assessed length of stay (LOS) and investigated factors associated with a prolonged LOS in patients who had MIH for benign and malignant conditions in our health system. We performed a retrospective cohort study using data obtained from our health system’s electronic medical record. Adult, female patients who had a straight-stick or robotic assisted laparoscopic hysterectomy between January 1, 2016 to October 9, 2020 at one of the six Catholic Health hospitals, for benign or malignant conditions, were included. Cases converted to a laparotomy were excluded. Prolonged LOS was defined as a LOS > 75%ile. Logistic regression model fitting was used to determine the patient and/or peri-operative factors associated with an increased post-operative LOS. We included 1096 patients in our analysis. 69.0% self-identified as White, 13.4% as Black, 1.3% Asian and 16.3% Other. 16.5% identified ethnically as Hispanic or Latino. 944 of the 1096 patients underwent MIH for benign conditions while the remainder did so for malignant conditions. 530 patients underwent straight-stick MIH while 566 underwent robot assisted MIH. The average LOS was 30.9 hours (SD= 21.2). One hundred and sixty-one patients had a prolonged LOS (> 33 hours). Factors associated with a prolonged LOS included the following: injury and repair of the bowel (OR 17.7, CI 1.8 – 171.6) or bladder (OR 8.9, CI 1.5 – 53.4), staging for gynecologic malignancy (OR 2.8, CI 1.8 – 4.3), diagnosis of endometrial carcinoma (OR 2.2, CI 1.4 – 3.4), age >70 years old (OR 2.1, 1.2 – 3.5), and non-Hispanic ethnicity (OR 1.8, 1.0 – 3.0). In this cohort, 90-day ED visit rates were 8.7% in the <75%ile and 18% in >75%ile, 90-day readmission rates were 3.6% in those whose LOS was ≤ 75%ile and 9.9% for those with a LOS > the 75%ile (p<0.01). Reoperation rates were 1.4% in the <75%ile group vs 6.8% in the >75%ile group. In this cohort (p<0.01). In our analysis we found various demographic, pre-operative and intra-operative factors influenced post-operative LOS. Of these, only the avoidance of an intra-operative bowel or bladder injury may be considered modifiable. Not surprisingly, MIH performed for a gynecologic malignancy was associated with a prolonged LOS. What is notable is that the patients that went home sooner did not have higher rates of ED visits, readmission and reoperation in the prolonged LOS compared to the <75%ile.