title: The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications.
abstract: OBJECTIVE
  This study aimed to report the feasibility and safety of same-day discharge after robotic-assisted hysterectomy.
  
  
  METHODS
  Same-day discharge after robotic-assisted hysterectomy was initiated 07/2010. All cases from then through 12/2012 were captured for quality assessment monitoring. The distance from the hospital to patients' homes was determined using http://maps.google.com. Procedures were categorized as simple (TLH+/-BSO) or complex (TLH+/-BSO with sentinel node mapping, pelvic and/or aortic nodal dissection, appendectomy, or omentectomy). Urgent care center (UCC) visits and readmissions within 30days of surgery were captured, and time to the visit was determined from the initial surgical date.
  
  
  RESULTS
  Same-day discharge was planned in 200 cases. Median age was 52years (range, 30-78), BMI was 26.8kg/m(2) (range, 17.4-56.8), and ASA was class 2 (range, 1-3). Median distance traveled was 31.5miles (range, 0.2-149). Procedures were simple in 109 (55%) and complex in 91 (45%) cases. The indication for surgery was: endometrial cancer (n=82; 41%), ovarian cancer (n=5; 2.5%), cervical cancer (n=8; 4%), and non-gynecologic cancer/benign (n=105; 53%). One hundred fifty-seven (78%) had successful same-day discharge. Median time for discharge for these cases was 4.8h (range, 2.4-10.3). Operative time, case ending before 6pm, and use of intraoperative ketorolac were associated with successful same-day discharge. UCC visits occurred in 8/157 (5.1%) same-day discharge cases compared to 5/43 (11.6%) requiring admission (P=.08). Readmission was necessary in 4/157 (2.5%) same-day discharge cases compared to 3/43 (7.0%) requiring admission (P=.02).
  
  
  CONCLUSIONS
  Same-day discharge after robotic-assisted hysterectomy for benign and malignant conditions is feasible and safe.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Bianca
authors.initials: B
authors.lastname: Calderon
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Mays
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nolan
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Electronic address: leitaom@mskcc.org.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D020910:Ketorolac / Q000627:therapeutic use; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D010351:Patient Discharge; D061214:Patient Safety; D012189:Retrospective Studies; D012371:Robotics; D058994:Salpingectomy / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D014591:Uterine Diseases / Q000601:surgery*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac
keywords: BSO; Robotic-assisted hysterectomy; Same-day discharge; TLH