Same day dismissal for endometrial cancer robotic surgery: Feasibility factors (005)

Abstract

<b>Objectives:</b> To investigate factors determining the feasibility and safety of same-day dismissal (SDD) of patients after robotic hysterectomy and associated lymph node procedures for endometrial cancer. <b>Methods:</b> A single-institution retrospective chart review was performed of patients with pathologic diagnosis of endometrial cancer who underwent robotic hysterectomy and associated lymph nodes procedures between 2012 and 2021. Outcomes were analyzed by discharge to home, which was categorized as SDD or hospitalization at least for one night (not-SDD). Patient demographics, past medical and surgical history, intra and postoperative events were examined as possible factors related to not-SDD. These factors were analyzed using multivariate logistic regression and univariate analysis (Chi-square test). <b>Results:</b> Of the 292 patients, 117 (40%) had SDD, and 175 (60%) had not-SDD. The rate of SDD has been increasing over time, with up to 88% of patients annually avoiding overnight stay (Figure 1). The factors significantly associated with not-SDD (p<0.05) included surgery in the first five years after the introduction of the SDD protocol (2012-2016), patient age >75 years, presence of comorbid conditions such as cardiovascular disease, anemia (Hb< 11 g/dl) and those on anticoagulant therapy. Additionally, factors including extensive adhesiolysis, the performance of full pelvic and/or aortic lymphadenectomy, operating time >180 minutes, and surgery start time after 2:00 pm were significantly more associated with not-SDD. Interestingly, the use of the sentinel lymph node sampling was significantly associated with achieving SDD (OR: 0.050; 95% CI: 0.273-0.934, p=0.029). No significant difference in complications or re-admissions was found. <b>Conclusions:</b> In this tertiary referral center for minimally invasive treatment of endometrial cancers, SDD hysterectomy with related oncologic procedures is feasible and safe with similar complications and re-admission rates even in the complex clinical scenario of obese patients with comorbid conditions. Multiple risk factors for the failure of the SDD protocol were recognized. Care must be taken for the selection of patients, application of enhanced recovery after surgery (ERAS) protocol, and proper surgical planning to achieve SDD after robotic endometrial cancer surgery.