Predictors of Same-Day Discharge after Minimally Invasive Hysterectomy

Study Objective To identify patient, surgeon and hospital characteristics that predict same-day discharge after minimally invasive hysterectomy (MIH) Design Cross-sectional Setting Five-hospital healthcare system Patients or Participants Women undergoing benign laparoscopic or robotic-assisted hysterectomy from 7/1/2014 to 2/28/2019. Interventions NA Measurements and Main Results Independent variables included patient characteristics (age, BMI, comorbidities, race, insurance, uterine size on pre-operative imaging, indication for surgery, distance from hospital), surgical characteristics (route of surgery, concomitant procedures, EBL, duration in OR, start time of case), and surgeon/hospital characteristics (academic vs. community, surgeon specialty, surgeon volume, resident participation). Multivariate logistic regression was used to assess the odds of same-day discharge (POD#0). Among 2,081 MIHs performed, 610 (29.3%) were discharged on POD#0. Same-day discharge increased from 22.7% in 2015 to 37.3% in 2019 (p<0.001). Discharge on POD#0 was more likely with the following factors: MIGS-trained surgeon (OR 10.7 [95%CI 3.0-38.7]), resident participation (OR 2.2 [1.2-4.2]), shorter case duration (<100 min, all discharged home on POD#0; 100-150 min; OR 2.6 [1.3-5.6]), and high-volume surgeon (4-8 or more hysterectomies/month, OR 4.4-81.4 [2.5-1713.6]). Discharge on POD#0 was less likely with the following factors: ≥4 comorbidities (OR 0.10 [0.02-0.45]), low-volume surgeon (<0.5 hysterectomies/month, OR 0.01 [0.00-0.26]), higher EBL (100-250cc, OR 0.54 [0.32-0.98]; 250-500cc, OR 0.29 [0.14-0.59]; >500cc, OR 0.07 [0.02-0.25]), start time after 4pm (OR 0.05 [0.00-0.62]), longer case duration (200-250 min, OR 0.56 [0.37-0.92]; >250 min, OR 0.54 [0.30-0.97]), and living >100 miles from the hospital (OR 0.23 [0.06-0.81]). Conclusion Patient, surgical, and surgeon factors all influence the timing of post-operative discharge. If teams are interested in increasing same-day discharge after MIH, scheduling ideal candidates (based on predictive factors above) earlier in the day could help achieve this goal. Lastly, if a patient is interested in same-day discharge, referral to a high-volume and/or MIGS-trained surgeon could be considered. To identify patient, surgeon and hospital characteristics that predict same-day discharge after minimally invasive hysterectomy (MIH) Cross-sectional Five-hospital healthcare system Women undergoing benign laparoscopic or robotic-assisted hysterectomy from 7/1/2014 to 2/28/2019. NA Independent variables included patient characteristics (age, BMI, comorbidities, race, insurance, uterine size on pre-operative imaging, indication for surgery, distance from hospital), surgical characteristics (route of surgery, concomitant procedures, EBL, duration in OR, start time of case), and surgeon/hospital characteristics (academic vs. community, surgeon specialty, surgeon volume, resident participation). Multivariate logistic regression was used to assess the odds of same-day discharge (POD#0). Among 2,081 MIHs performed, 610 (29.3%) were discharged on POD#0. Same-day discharge increased from 22.7% in 2015 to 37.3% in 2019 (p<0.001). Discharge on POD#0 was more likely with the following factors: MIGS-trained surgeon (OR 10.7 [95%CI 3.0-38.7]), resident participation (OR 2.2 [1.2-4.2]), shorter case duration (<100 min, all discharged home on POD#0; 100-150 min; OR 2.6 [1.3-5.6]), and high-volume surgeon (4-8 or more hysterectomies/month, OR 4.4-81.4 [2.5-1713.6]). Discharge on POD#0 was less likely with the following factors: ≥4 comorbidities (OR 0.10 [0.02-0.45]), low-volume surgeon (<0.5 hysterectomies/month, OR 0.01 [0.00-0.26]), higher EBL (100-250cc, OR 0.54 [0.32-0.98]; 250-500cc, OR 0.29 [0.14-0.59]; >500cc, OR 0.07 [0.02-0.25]), start time after 4pm (OR 0.05 [0.00-0.62]), longer case duration (200-250 min, OR 0.56 [0.37-0.92]; >250 min, OR 0.54 [0.30-0.97]), and living >100 miles from the hospital (OR 0.23 [0.06-0.81]). Patient, surgical, and surgeon factors all influence the timing of post-operative discharge. If teams are interested in increasing same-day discharge after MIH, scheduling ideal candidates (based on predictive factors above) earlier in the day could help achieve this goal. Lastly, if a patient is interested in same-day discharge, referral to a high-volume and/or MIGS-trained surgeon could be considered.