title: Laparoscopic surgery for endometrial cancer: why don't all patients go home the day after surgery?
abstract: OBJECTIVE
  To identify risk factors for hospital length of stay (LOS) longer than 1 postoperative day in patients undergoing laparoscopic hysterectomy because of endometrial cancer.
  
  
  METHODS
  Retrospective observational study (Canadian Task Force classification II-2).
  
  
  METHODS
  Tertiary-care university hospital.
  
  
  METHODS
  One hundred thirty-three patients undergoing laparoscopic hysterectomy because of endometrial cancer between August 2006 and August 2010.
  
  
  METHODS
  One hundred thirty-three women underwent traditional laparoscopy. In 101 of these patients, lymph node sampling was performed.
  
  
  RESULTS
  Seventy-four women (55%) were discharged on postoperative day 1. The percentage of women discharged on postoperative day 1 (POD1) vs after POD 1 did not differ by extent of staging. Risk of perioperative complications was associated with hospital LOS longer than POD1 (odds ratio [OR], 11.45; 95% confidence interval [CI], 1.40-94.39). Procedure start time after 3:00 pm (OR, 3.20; 95% CI, 1.14-9.04) and procedure end time after 5:00 pm (OR, 2.47; 95% CI, 1.17-5.20) were independent factors associated with hospital LOS beyond POD1. There was a nonsignificant tendency toward later hospital discharge with administration of intravenous narcotic agents.
  
  
  CONCLUSIONS
  Laparoscopic surgery to treat endometrial cancer should be preferentially scheduled early in the day to facilitate discharge on POD1. The extent of staging lymphadenectomy performed does not increase hospital stay beyond POD1.
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. rjspencer@partners.org
authors.forename: Ryan
authors.initials: R
authors.lastname: Spencer
authors.forename: John
authors.initials: J
authors.lastname: Schorge
authors.forename: Marcela
authors.initials: M
authors.lastname: Del Carmen
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.forename: Whitfield
authors.initials: W
authors.lastname: Growdon
authors.forename: David
authors.initials: D
authors.lastname: Boruta
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016001:Confidence Intervals; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010388:Pelvis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid