Predictors of Overnight Admission after Minimally Invasive Hysterectomy in the Expert Setting.

OBJECTIVE: To identify predictors of Same Day Discharge (SDD) overnight admission after laparoscopic and robot-assisted hysterectomy to improve preoperative counseling and patient optimization.

DESIGN: A Single-center retrospective cohort study. (Canadian Task Force classification III).

SETTING: Academic university hospital.

PATIENTS: Patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by fellowship-trained minimally invasive gynecologic surgeons for benign indications INTERVENTIONS: Straight-stick laparoscopic and robot-assisted hysterectomy. Same Day Discharge (SDD) after surgery.

MAIN OUTCOME MEASURES: SDD vs. overnight stay. All preoperative, intraoperative, variables were collected for analysis as predictors.

RESULTS: Data from 396 consecutive minimally invasive hysterectomy procedures was collected for analysis. Three hundred and twelve patients (79%) were discharged the same day, 84 (21%) were admitted for at least one night. Data from the two groups were compared. Overnight stay compared to SDD was associated with older age (47.3 vs. 43.4 years, P< 0.001), lower preoperation hematocrit (35.8% vs. 37.3%, P= 0.035), history of prior laparotomy (31% vs. 14.1%, P=0.003), prolonged operative time (190.5 vs. 115.2 min, P<0.001), estimated blood loss (244.6 vs. 104.1 mL P<0.001), lysis of adhesion (27.4% vs. 13.5%), and intraoperative organ injury (17% vs. 3%, P=0.005). Logistic regression analysis, adjusting for all included variables as confounders, showed that hematocrit increments of 5%, was protective against any overnight stay, OR 0.622 (p=0.015), 30 minutes increase in operative time increased the odds of an overnight stay by 1.6 (P<0.001). History of a laparotomy remained a significant predictive factor for an overnight stay, OR 3.2 (p=0.006). Later surgery end time, by increments of 60 minutes, increased the odds of an overnight stay by 1.2 (p<0.01).

CONCLUSION: Perioperative factors such as age, hematocrit, surgery time, and surgical history as well as intraoperative factors such as prolonged operative time are predictive of overnight hospital stay.