Feasibility and safety of same-day discharge after laparoscopic radical hysterectomy for cervix cancer

Objective. To evaluate the safety and feasibility of same day-discharge (SDD) after laparoscopic radical hysterectomy for cervix cancer by determining complication rates and factors associated with post-operative admission. Methods. In this retrospective cohort study, patients undergoing laparoscopic radical hysterectomy for cervix cancer at a single institution from January 2006 to November 2015 were identified. Admitted patients were compared to same-day discharge patients. Rates of post-operative complications and readmission were analyzed and regression analysis used to determine factors associated with admission. Results. 119 patients were identified. 75 (63%) were SDD patients (mean stay 156.7 +/- 50.2 min) and 44 (37%) were admitted patients (mean stay 1.2 +/- 0.6 days). Ten (13%) SDD patients sought medical attention within 30 days post-operatively vs. nine (20%) admitted patients (p = 0.17). Reasons SDD patients sought attention included pain (n = 1), wound concems (n = 2), vaginal bleeding (n = 2), DVT/VTE (n = 1), fever (n = 2) and fistula (n = 2). All patients developed symptoms and presented between 5 and 13 days post-operatively thus no complications could have been detected or prevented through initial admission. Four SDD patients were readmitted within 30 days of surgery (p = 0.25), two required re-operation (p = 0.16). Admitted patients were older (p = 0.049), had longer operations (p = 0.02), increased blood loss (p = 0.0004), increased intraoperative complications (p = 0.001), surgery later in the day (p = 0.004) and before April 2010 (p = 0.001). On multivariate analysis, older age (OR1.05, p = 0.03), surgery later in the day (OR 7.22, p = 0.002) and presence of an intra-operative complication (OR 10.25, p = 0.02) were significantly associated with admission. Conclusion. Same-day discharge after laparoscopic radical hysterectomy for cervix cancer is safe, with a low risk of post-operative morbidity and hospital readmission. (C) 2017 Elsevier Inc. All rights reserved.