Same-day discharge after laparoscopic hysterectomy for endometrial cancer

Melamed, Alexander; Eriksen, Jennifer L. Katz; Hinchcliff, Emily; Worley, Michael J.; Berkowitz, Ross S.; Horowitz, Neil S.; Muto, Michael G.; Feltmate, Colleen M.

doi:10.1016/j.ygyno.2015.01.088

Cited by 4 publications

(16 citation statements)

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“…Regardless of these limitations, RAS seems to be associated with increased cost compared with the equivalent laparoscopic procedures although there is evidence that increased operative efficiency, in particular a decrease in procedure time, may reduce the overall costs . Many institutions routinely apply the potential for same day discharge, which could further decrease the costs in both RAS and CL .…”

Section: Resultsmentioning

confidence: 99%

Robot‐assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions – a systematic review

Kristensen

Mosgaard

Rosendahl

et al. 2017

Acta Obstet Gynecol Scand

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Introduction. Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. Material and methods. A database search in PubMed and EMBASE was performed up until 4 March 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human participants and English language were the only restrictive filters applied. Selection was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. Results. Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous surgical methods. Controversies arise because current knowledge does not clearly document the benefit of robot-assisted surgery, on perioperative outcome compared with the increased costs of the acquisition and application. Conclusions. The rapid development in robot-assisted surgery calls for long-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application, and maintenance have an unfavorable impact on cost-benefit evaluations, especially when compared with laparoscopy. Future developments in robot-assisted surgery will hopefully lead to competition in the market, which will decrease costs.

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Section: Resultsmentioning

confidence: 99%

Robot‐assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions – a systematic review

Kristensen

Mosgaard

Rosendahl

et al. 2017

Acta Obstet Gynecol Scand

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“…A further 39 studies were excluded owing to full study texts being unavailable and 277 full‐text articles were excluded after being reviewed for meeting the exclusion criteria. There were 15 articles included in the systematic review. It was not possible to perform stratified analyses between any minimally invasive surgical procedures and no randomized controlled trials were identified so no meta‐analyses were performed.…”

Section: Resultsmentioning

confidence: 99%

“…Of the six prospective studies retrieved, four examined total laparoscopic hysterectomy, one included robotic‐assisted laparoscopic hysterectomy, and one included laparoscopic supra‐cervical hysterectomy. Among the nine retrospective studies, five included two or three procedures: total laparoscopic hysterectomy and robotic‐assisted laparoscopic hysterectomy (two studies), total laparoscopic hysterectomy and laparoscopic supra‐cervical hysterectomy (two studies), and total laparoscopic hysterectomy, laparoscopically assisted vaginal hysterectomy, and laparoscopic supra‐cervical hysterectomy (one study); three studies included robotic‐assisted laparoscopic hysterectomy only; and one study included total laparoscopic hysterectomy only (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The studies included small (n=16–43 patients), medium (n=88–696 patients), and large‐scale studies (n=1015–8890 patients) . There were nine studies conducted in the USA, one in Canada, and five in Europe . There were six studies that included patients with both malignant and benign indications for hysterectomy and there were 1707 (14.2%) patients included in the review that had malignant indications for surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Re‐admission was analyzed from 24 hours to 12 months after discharge; however, some studies did not specify re‐admissions times. Among 2218 patients included in the six studies that included discharge before midnight as a clear definition of same‐day discharge, 66 (5.5%) of 1211 patients who were discharged on the day of surgery were re‐admitted within 12 months, compared with a readmission rate of 305 of 9774 (3.1%) patients from studies with no clearly defined cut‐off time for same‐day discharge.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of same‐day discharge after minimally invasive hysterectomy

Korsholm

Mogensen

Jeppesen

et al. 2016

Intl J Gynecology & Obste

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Background: Same-day discharge has been suggested to safe and acceptable following minimally invasive hysterectomy. Objectives:To evaluate the feasibility of same-day discharge following minimally invasive hysterectomy and to identify associated factors. Search strategy: Medline, Embase and the Cochrane Central Register of ControlledTrials were systematically searched using the terms "same day discharge", "minimally invasive surgery", and "hysterectomy" between October 1 and October 31, 2015. No language or publication date restrictions were included.Selection criteria: Randomized controlled trials and observational studies evaluating same-day discharge before midnight on the day of minimally invasive hysterectomy were included.Data collection and analysis: Study characteristics, pre-operative selection criteria, and predictive factors for same-day discharge were analyzed.Main results: There were 15 observational studies with 11 992 patients included.Significant heterogeneity was observed in the studies, and publication and selection bias could have potentially affected the results. All the studies concluded that sameday discharge was feasible. However, some factors were associated with a decreased possibility of same-day discharge; these were older age, beginning surgery later than 1:00 pm and completing surgery later than 6:00 pm, longer duration of operation, and high estimated blood loss.Conclusions: Same-day discharge appears feasible for a majority of patients who undergo minimally invasive hysterectomies if adequate emphasis is placed on presurgical planning and careful patient selection.

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Effect of length of hospital stay on infection and readmission after minimally invasive hysterectomy

Schiff

Voltzke

Strassle

et al. 2019

Intl J Gynecology & Obste

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Objective To assess the effect of length of hospital stay on postoperative outcomes after minimally invasive hysterectomy. Methods A retrospective cohort analysis was conducted of women who underwent minimally invasive hysterectomy (vaginal or laparoscopic) for benign conditions between January 1, 2014 and December 31, 2016, using the American College of Surgeons National Surgical Quality Improvement Program database. Patient information and 30‐day outcomes were compared using multivariable logistic regression after adjusting for patient demographics and medical and procedure variables. Results The analysis included 31 347 patients. Women discharged the day after surgery were more likely to be African‐American, older, have prior abdominal surgery, and a higher ASA classification. Prevalence of organ space infection and readmissions were lower in the same day discharge group. No differences between same‐ and next‐day discharge were found for surgical site infection or urinary tract infection (adjusted odds ratios (aORs) 0.83 (95% [CI] 0.65–1.07; P=0.156) and 0.85 (95% CI 0.68–1.06; P=0.151), respectively). Same‐day hospital discharge was associated with a reduced chance of readmission (aOR=0.68, 95% CI 0.54–0.87; P=0.002). Conclusion Same‐day hospital discharge after minimally invasive hysterectomy lowered the risk of readmission and did not increase the risk of postoperative complications.

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Same-day discharge after laparoscopic hysterectomy for endometrial cancer

Cited by 4 publications

References 0 publications

Robot‐assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions – a systematic review

Robot‐assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions – a systematic review

Systematic review of same‐day discharge after minimally invasive hysterectomy

Effect of length of hospital stay on infection and readmission after minimally invasive hysterectomy

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