paywalled: Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Blogger's Note/Opinion: while this is not ovarian cancer surgery but endometrial cancer surgery, the surgery described is the same; drive thru mastectomies, cancer surgeries - amazing really -  disgusting might be a more accurate term with a reminder that studies can and often do make policy, the abstract does not define many factors involved in gyn cancer surgeries and notable is the lack of any indication of followup period (of time), readmission rates (days) can vary depending on the hospital.....
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Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Clinical Study
Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy
Mark A. Rettenmaier, Alberto A. Mendivil, John V. Brown, III, Lisa N. Abaid, John P. Micha, Bram H. Goldstein

Gynecologic Oncology Associates, Newport Beach, Calif., USA

Address of Corresponding Author
Oncology 2012;82:321-326 (DOI: 10.1159/000337573)

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   Abstract
Objectives:

The purpose of this retrospective study was to evaluate the capacity for same-day discharge in clinical stage I endometrial cancer (EC) patients treated with total laparoscopic hysterectomy (TLH), bilateral salpingo-oophorectomy (BSO) and bilateral pelvic lymph node dissection (BPLND).  

Methods:
We retrospectively reviewed the charts of stage I EC patients who were treated with TLH, BSO and BPLND and discharged on the same day. The intra- and postoperative clinical variables (e.g., age, complications, surgery time, patient hospital stay) were evaluated in an attempt to discern which factors may predispose a patient to same-day discharge.

Results:
Twenty-one patients were successfully discharged on the same day of surgery. Mean operative time was 1.48 h and length of hospital stay was 6.35 h. There were no intraoperative complications or hospital readmissions.  

Conclusions:
We present a single, institutional experience solely assessing the capacity for same-day discharge in clinical stage I EC patients treated with TLH, BSO and BPLND. Since the postoperative complication rate was minimal with no hospital readmissions, we suggest that particularly selected stage I EC patients are amenable to outpatient management.
Copyright © 2012 S. Karger AG, Basel

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  Author Contacts
Bram H. Goldstein, PhD
Gynecologic Oncology Associates
351 Hospital Road, Suite 507
Newport Beach, CA 92663 (USA)
Tel. +1 949 642 5165, E-Mail bram@gynoncology.com

full free access: Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology

OBJECTIVE: The purpose of this study is to evaluate whether same-day discharge after laparoscopic gynecologic oncology surgery is feasible and determines factors associated with admission.

METHODS: This retrospective cohort study included all patients consented for laparoscopy by two gynecologic oncologists at a tertiary care academic teaching hospital between January 2006 and June 2009. Procedures included those not typically discharged same-day, such as total laparoscopic simple or radical hysterectomies or radical trachelectomy +/- salpingo-oophorectomy +/- pelvic and para-aortic lymph node dissection +/- omentectomy. Those discharged same-day were compared to those admitted. Multivariate logistic regression analysis was done to determine factors associated with admission.

RESULTS: Three hundred three patients were included. 6.9% were converted to laparotomy. One hundred forty-seven (48.5%) had same-day discharge (median stay 295minutes). Among outpatients, 7 (4.8%) were readmitted within three weeks of surgery. Three patients (2%) could have avoided the ER or hospital admission had they been originally admitted postoperatively. No patients with same-day discharge had a major acute postoperative complication. Factors associated with admission include age (OR 1.76 for age 70years vs 50years, p=0.001), surgeon (OR 6.91, p<0.0001), conversion to laparotomy (p<0.0001), radical hysterectomy (OR 3.43, p=0.002), length of surgery (OR 2.94 for 4hours vs 2hours, p<0.0001), and surgery start time after 1PM (OR 3.77, p=0.0001).

CONCLUSION: Same-day discharge for laparoscopic gynecologic oncology surgery is feasible, with low morbidity and few readmissions within three weeks of surgery. Successful same-day discharge can increase by refining patient selection and operating room scheduling.