title: Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology.
abstract: OBJECTIVE
  The purpose of this study is to evaluate whether same-day discharge after laparoscopic gynecologic oncology surgery is feasible and determines factors associated with admission.
  
  
  METHODS
  This retrospective cohort study included all patients consented for laparoscopy by two gynecologic oncologists at a tertiary care academic teaching hospital between January 2006 and June 2009. Procedures included those not typically discharged same-day, such as total laparoscopic simple or radical hysterectomies or radical trachelectomy +/- salpingo-oophorectomy +/- pelvic and para-aortic lymph node dissection +/- omentectomy. Those discharged same-day were compared to those admitted. Multivariate logistic regression analysis was done to determine factors associated with admission.
  
  
  RESULTS
  Three hundred three patients were included. 6.9% were converted to laparotomy. One hundred forty-seven (48.5%) had same-day discharge (median stay 295minutes). Among outpatients, 7 (4.8%) were readmitted within three weeks of surgery. Three patients (2%) could have avoided the ER or hospital admission had they been originally admitted postoperatively. No patients with same-day discharge had a major acute postoperative complication. Factors associated with admission include age (OR 1.76 for age 70years vs 50years, p=0.001), surgeon (OR 6.91, p<0.0001), conversion to laparotomy (p<0.0001), radical hysterectomy (OR 3.43, p=0.002), length of surgery (OR 2.94 for 4hours vs 2hours, p<0.0001), and surgery start time after 1PM (OR 3.77, p=0.0001).
  
  
  CONCLUSIONS
  Same-day discharge for laparoscopic gynecologic oncology surgery is feasible, with low morbidity and few readmissions within three weeks of surgery. Successful same-day discharge can increase by refining patient selection and operating room scheduling.
authors.affiliation: Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Lilian.Gien@sunnybrook.ca
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Gien
authors.forename: Rachel
authors.initials: R
authors.lastname: Kupets
authors.forename: Allan
authors.initials: A
authors.lastname: Covens
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards*; D012189:Retrospective Studies