Same-day discharge after laparoscopic hysterectomy ‘poses no safety concerns’

By Piriya Mahendra, medwireNews Reporter

Researchers say that patients undergoing laparoscopic hysterectomy can be discharged the same day, with no associated safety concerns.

Jason Wright (Columbia University, New York, USA) and team found that women discharged on the same day as undergoing the procedure were more likely to require re-evaluation 60 days on than those discharged a day later, but this re-evaluation risk was low, according to the authors.

Wright told medwireNews: "The risk [from same-day discharge] is that a patient would potentially have a complication or problem that you couldn't detect, like bleeding or substantial pain." However, he added: "Our study showed that the rates of readmission were low and that this appears to be safe."

Wright and team identified 128,634 women from the Perspective database who underwent laparoscopic hysterectomy between 2000 and 2010. Of these 34,070 (26.5%) were discharged later that day.

The overall rate of re-evaluation within 60 days for women who underwent laparoscopic hysterectomy was 4.0% for those discharged on the day of surgery, 3.6% for women who stayed in hospital for a day, and 5.1% for patients who stayed for 2 days or more.

As reported in the American Journal of Obstetrics and Gynecology, a multivariate model of factors associated with re-evaluation showed that patients discharged on postoperative day 1 were 11% less likely to require re-evaluation than those discharged on the day of surgery.

Same-day discharge significantly increased from 11.3% in 2000 to 46.0% in 2010. Multivariate analysis revealed that year of diagnosis was the strongest predictor for same-day discharge. Patients who underwent the surgical procedure in 2003 or 2004 had a 19% increased chance of being discharged the same day compared with those who underwent surgery between 2000 and 2002.

Wright explained that clinicians remain cautious about implementing same-day discharge. "There hasn't been much prior data looking at early discharge after laparoscopic hysterectomy so it's been hard for clinicians to say that its safe. The procedure is also relatively new."

He believes that the protocol will become more common as time goes on and further data become available. "For other procedures like laparoscopic cholecystectomy the length of stay gradually shortened once studies showed that earlier discharge was safe," he pointed out.

Multivariate analysis also revealed that compared with a same-day procedure, costs were US$ 207 (€ 160) higher for patients who had a 1-day stay and US$ 1383 (€ 1068) higher for those with a stay of 2 or more days.

Wright concluded: "We believe that the findings suggest that earlier discharge after laparoscopic hysterectomy is safe and should be considered in patients. Further studies to determine patients who would benefit from longer observation still need to be performed."

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