Same-Day Discharge After Laparoscopic Hysterectomy

Perron-Burdick, Misa; Yamamoto, M.; Zaritsky, Eve

doi:10.1097/aog.0b013e318215dd4e

Cited by 101 publications

(79 citation statements)

References 8 publications

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“…[1][2][3][4] Our population-based study found that 30-day revisits for clinically significant surgical site infections following ambulatory operations accounted for less than 15% of all-cause revisits to inpatient or ambulatory surgery settings. 5 The reasons for other revisits and their relationship to the index operation are unknown.…”

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confidence: 99%

Return to Acute Care Following Ambulatory Surgery

Steiner

Maggard-Gibbons

Raetzman

et al. 2015

JAMA

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Two-thirds of operations are performed on an outpatient basis, yet little research has assessed their quality. [1][2][3][4] Our population-based study found that 30-day revisits for clinically significant surgical site infections following ambulatory operations accounted for less than 15% of all-cause revisits to inpatient or ambulatory surgery settings. 5 The reasons for other revisits and their relationship to the index operation are unknown. This study determined the rates of all-cause, unplanned revisits (ie, not for routine medical care) within 30 days of ambulatory surgery and whether revisits were related to the operation.Methods | We performed a retrospective analysis of 6 low-to moderate-risk ambulatory operations spanning a range of specialties and complexity. We used the 2010-2011 Healthcare Cost and Utilization Project (HCUP) State Ambulatory Surgery and Services Databases, State Inpatient Databases, and State Emergency Department Databases for 7 states with unique, encrypted patient numbers (representing approximately one-third of the US population), allowing linkage of the ambulatory operations with 30-day postoperative, unplanned acute care revisits. 6 We identified index ambulatory operations performed in hospital-owned settings for adults with low surgical risk (single operation; no infection, cancer, or acute care in prior 30 days). We determined 30-day revisit rates per 1000 operations by setting (inpatient, ambulatory surgery, or emergency department [ED]). A patient with a revisit was counted once; priority was hierarchically assigned as inpatient, then ambulatory surgery, and then ED.The reason for the revisit (based on first-listed diagnosis code) was categorized as a complication related to the operation or an unrelated condition. The categories were developed iteratively using a combination of prospective and empirical methods.First, 2 of the authors (M.M-G. and G.D.S; who are surgeons) created categories a priori of known complications for each operation; revisit diagnosis codes were identified and assigned to these categories. Second, the 2 surgeons along with a third physician (C.A.S., who is an internist) reviewed the remaining revisits and empirically developed additional categories. To ensure face validity, the related complication categories were analyzed for consistency with procedures, and the unrelated conditions were reviewed to ensure that conditions were not miscategorized.We further characterized related complications by reason for revisit and present the 2 most frequent types: operation specific and pain (abdominal and other). The Agency for Healthcare Research and Quality institutional review board waived the need for informed consent because data were deidentified. Results | There were 482 034 ambulatory operations and 45 760 all-cause 30-day revisits (94.9 per 1000 operations; Table 1). Most revisits were to the ED (58.7 per 1000), followed by inpatient and ambulatory surgery settings (27.0 and 9.2 per 1000, respectively). Revisit rates to the inpatient and ED settings ...

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confidence: 99%

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Steiner

Maggard-Gibbons

Raetzman

et al. 2015

JAMA

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“…Several investigators have demonstrated the feasibility and safety of same-day discharge following hysterectomy for benign diagnoses [10,14,15]. de Lapasse et al [13] documented that 97.1% of such patients could also be successfully discharged within 24 h of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Perron-Burdick et al [15] evaluated the potential for same-day discharge with 1,015 patients following treatment with laparoscopic hysterectomy. In their study, 52% of the patients (TLH = 240; supracervical hysterectomy = 287) were discharged on the same day of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Although their study examined 150 EC patients, they included all stages of disease and surgical management varied. Consequently, the potential for same-day discharge after uniform treatment of a specific cancer indication remains indeterminate [9,15]. …”

Section: Discussionmentioning

confidence: 99%

“…More recently, research has evaluated the feasibility of same-day discharge following hysterectomy for both benign and malignant diagnoses [9,12,13,14,15]. Nevertheless, in the investigations mentioned thereof, several different conditions (e.g., malignancy, infection, wound dehiscence) were considered (i.e., none focused exclusively on a precise cancer subtype); thus, one may find it difficult to determine which specific diagnosis is the most amenable to same-day discharge.…”

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confidence: 99%

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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

Rettenmaier

Mendivil²,

Brown³

et al. 2012

Oncology

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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 ofstage 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.

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Extended Follow-up of a Randomized Clinical Trial of Open vs Endoscopic Release Surgery for Carpal Tunnel Syndrome

Atroshi

Hofer

Larsson

et al. 2015

JAMA

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efforts and pay-for-performance initiatives. Considering the burden of revisits to patients and hospitals following ambulatory operations, our study highlights the importance of expanding health policy and clinical interventions to include ambulatory surgery and complications assessed in the ED.Future work should determine associated risk factors and which complications are potentially preventable.follow-up (mean [SD] change from baseline, 1.8 [0.8]; from 1 year, −0.003 [0.6]). Adjusted mean between-group difference in change from baseline was −0.03 (95% CI, −0.25 to 0.19; P = .79) and from 1 year was −0.03 (95% CI, −0.23 to 0.17; P = .76). No between-group differences were found in the secondary outcomes ( Table 2).Discussion | To our knowledge, this is the first randomized trial to evaluate long-term outcomes of CTS surgery. After a mean follow-up of 12.8 years after CTS surgery, there were no significant differences between open and endoscopic carpal tunnel release. The large symptom and functional improvements and high level of patient satisfaction achieved with surgery were durable and few patients had undergone further surgery.Study limitations include a single institution in Sweden and unknown generalizability. Our long-term follow-up was limited to patient-reported outcomes, which are central in CTS and were consistent across several measures with established reliability and validity. The results should help clinicians and patients in making treatment decisions.

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Same-Day Discharge After Laparoscopic Hysterectomy

Abstract: Same-day discharge after laparoscopic hysterectomy is associated with low readmission rates and minimal emergency visits in the immediate postoperative period. Same-day discharge may be a safe option for healthy patients undergoing uncomplicated laparoscopic hysterectomy.

Cited by 101 publications

References 8 publications

Return to Acute Care Following Ambulatory Surgery

Return to Acute Care Following Ambulatory Surgery

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

Extended Follow-up of a Randomized Clinical Trial of Open vs Endoscopic Release Surgery for Carpal Tunnel Syndrome

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