Is Same-Day Discharge after Laparoscopic Hysterectomy a Safe Option?

Abstract

Study Objective: The purpose of this study is to examine the safety of same day discharge of patients after laparoscopic hysterectomy. Many gynecologic surgeons who perform laparoscopic hysterectomies admit their patients for one to two days; however a growing number of gynecologic surgeons are practicing same day discharge. To date there have been no large studies examining the safety of this practice.Design: This is a retrospective cohort study examining readmission rates up to 3 month postoperatively for same-day discharges after laparoscopic hysterectomy. Emergency room and urgent clinic visits within 48 and 72 hours of surgery, respectively, are also examined. Other secondary outcomes include estimated blood loss, operative time, and complication rate.Setting: The study takes place at Kaiser Permanente Northern California, a large health maintenence organization.Patients: A total of 531 patients who underwent same-day discharge after laparoscopic hysterectomy for benign indications were identified by electronic chart review.Intervention: No interventions were conducted for this study.Measurements and Main Results: Preliminary analysis demonstrates a readmission rate of < 5%, which is considerably lower than the 6% readmission rate determined by large studies on open hysterectomy and considered to be acceptable by expert opinion (p<.05). Secondary outcomes revealed that 8% of patient visited the emergency department within 48 hours of surgery and 3% had urgent clinic visits within 72 hours of surgery. Average estimated blood loss was 100ml and average operative time was 159 minutes. Postoperative complication rates were minimal.Conclusion: Same-day discharge of laparoscopic hysterectomy patients is a safe and acceptable alternative to admission, thus reducing the overall hospital and health care burden. Study Objective: The purpose of this study is to examine the safety of same day discharge of patients after laparoscopic hysterectomy. Many gynecologic surgeons who perform laparoscopic hysterectomies admit their patients for one to two days; however a growing number of gynecologic surgeons are practicing same day discharge. To date there have been no large studies examining the safety of this practice. Design: This is a retrospective cohort study examining readmission rates up to 3 month postoperatively for same-day discharges after laparoscopic hysterectomy. Emergency room and urgent clinic visits within 48 and 72 hours of surgery, respectively, are also examined. Other secondary outcomes include estimated blood loss, operative time, and complication rate. Setting: The study takes place at Kaiser Permanente Northern California, a large health maintenence organization. Patients: A total of 531 patients who underwent same-day discharge after laparoscopic hysterectomy for benign indications were identified by electronic chart review. Intervention: No interventions were conducted for this study. Measurements and Main Results: Preliminary analysis demonstrates a readmission rate of < 5%, which is considerably lower than the 6% readmission rate determined by large studies on open hysterectomy and considered to be acceptable by expert opinion (p<.05). Secondary outcomes revealed that 8% of patient visited the emergency department within 48 hours of surgery and 3% had urgent clinic visits within 72 hours of surgery. Average estimated blood loss was 100ml and average operative time was 159 minutes. Postoperative complication rates were minimal. Conclusion: Same-day discharge of laparoscopic hysterectomy patients is a safe and acceptable alternative to admission, thus reducing the overall hospital and health care burden.