Risk Factors, Morbidity, and Quality of Life Associated with Same-Day Discharge in Gynecologic Oncology

To determine the risk factors, morbidity, and quality of life associated with same-day surgery in gynecologic oncology. In this prospective study, patients with a good performance status and an indication for a simple procedure [diagnostic laparoscopy (peritoneal carcinomatosis index, biopsy, and Port-A-Cath), adnexectomy or fimbriectomy] and a complex procedure [total hysterectomy, omentectomy with peritoneal staging, pelvic lymphadenectomy (or sentinel lymph node (SLN)), and/or paraaortic lymphadenectomy by minimally invasive surgery] were included. Univariate logistic regression analysis, multivariate analysis, and the Wilcoxon signed-rank test were used in the statistical analyses. There were 171 consecutive surgeries (55 complex and 116 simple procedures). The rate of readmissions on the same day and at 30 days postoperatively was, respectively, 8% versus 3% with simple procedures and 16% versus 11% with complex procedures. We modified our procedure to decrease complications by prescribing prophylactic low molecular weight heparin (LMWH) the next day at 8 am at home instead of the evening before discharge (fewer vaginal hematomas after hysterectomy: 2 hematomas/5 hysterectomies with LMWH on the same day versus 0/22 with LMWH on the next day, P = 0.03). The following factors were significantly associated with readmission: complex procedure (odds ratio [OR] 4.25, 95% confidence interval [CI] 1.66–10.85, P = 0.003), absence of an exsufflation drain (OR 2.96, 95% CI 1.19–7.31, P = 0.019), and end of surgery after 2 pm (OR 5.82, 95% CI 2.13–15.94, P = 0.001). We modified our protocol to decrease complications (vaginal hematomas after hysterectomy) by prescribing prophylactic LMWH the next day at 8 am at home instead of the evening before discharge.