Safety Of Same-day Discharge Research Articles

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

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.

Safety of Same-Day Discharge after Radical Laparoscopic Surgery in Gynecologic Oncology

Safety of Same-Day Discharge after Radical Laparoscopic Surgery in Gynecologic Oncology

Safety of Same Day Discharge in Patients Undergoing Sutureless Thyroidectomy: A Comparison of Local and General Anesthesia

The thyroid gland is one of the most vascular organs in the body and surgical resection mandates meticulous surgical technique and hemostasis. The aim of this study was to assess the safety and efficacy of the electrothermal bipolar vessel sealing system in permitting ambulatory thyroid surgery under local anesthesia. From January 1, 2004, to December 31, 2005, 224 consecutive patients underwent thyroid surgery using the LigaSure for hemostasis. Whenever possible, local/regional anesthesia with conscious sedation was utilized during the procedure. A descriptive analysis was performed to evaluate patient characteristics and outcome measures. Eighty-two percent (n = 184) of all unselected patients presenting for thyroid surgery had their procedure performed under local/regional anesthesia with conscious sedation whereas 18% (n = 40) received general anesthesia. When comparing these two groups, the local anesthesia patients were more likely to be female (85% vs. 68%, p < or = 0.05) and younger (mean age = 50 vs. 61 years, p < or= 0.05). Forty percent of the local anesthesia patients underwent a total thyroidectomy compared to 58% in the general anesthesia group (p < or = 0.05). The mean duration of surgery was shorter in the local anesthesia patients (71 minutes vs. 101 minutes, p < or = 0.05) and the mean gland weight was also less (26.9 g vs. 63.9 g, p < or = 0.05). There was one hematoma in the local anesthesia group, but overall the morbidity was not different. Eighty-eight percent of the local anesthesia patients were discharged same day of surgery compared to 45% of the general anesthesia patients. The electrothermal bipolar vessel sealing system permits safe, same day discharge in patients undergoing thyroid surgery with a low complication rate irrespective of the type of anesthesia.