title: Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies.
abstract: OBJECTIVE
  The objective of the study was to evaluate the feasibility and safety of same-day discharge of patients undergoing minimally invasive comprehensive surgical staging for endometrial and cervical cancer.
  
  
  METHODS
  We performed a retrospective review of consecutive patients from January 2008 to December 2011 undergoing comprehensive staging for endometrial or cervical cancer by traditional laparoscopy or robotic-assisted laparoscopy and intended for same-day discharge. Patients accomplishing same-day discharge were compared with those who required admission. Clinical and demographic data, perioperative outcomes, and postoperative patient contacts within 6 weeks were collected. Multivariate logistic regression modeling was used to determine factors associated with admission and unscheduled patient contacts within 2 weeks of surgery.
  
  
  RESULTS
  A total of 141 patients were identified. One hundred eighteen patients (83.7%) underwent same-day discharge and 23 (16.3%) required overnight admission. The variables that significantly predicted overnight admission were severe pain in the postanesthesia care unit (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.74-26.6; P = .006), delayed ability to tolerate oral intake (OR, 9.3; 95% CI, 2.25-38.6, P = .002), traditional laparoscopic vs robotic-assisted surgical approach (OR, 9.05; 95% CI, 2.34-35.1; P = .001), and surgery start time at 2:00 pm or later (OR, 36.8; 95% CI, 6.19-219.3; P < .0001). There was no difference in the readmission rate between patients undergoing same-day discharge compared with overnight admission (11% vs 17%, P = .48). No variables significantly predicted unscheduled patient contact within 2 weeks of surgery at P < .01.
  
  
  CONCLUSIONS
  Same-day discharge for patients undergoing laparoscopic or robotic-assisted laparoscopic staging for endometrial or cervical cancer is feasible and safe. There are low complication rates and few readmissions or unscheduled patient contacts within 2 weeks of surgery.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Irvine Medical Center, Orange, CA.
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Penner
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Fleming
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
authors.forename: Leah
authors.initials: L
authors.lastname: Barlavi
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
authors.forename: Allison E
authors.initials: AE
authors.lastname: Axtell
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA. Electronic address: scott.e.lentz@kp.org.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Lentz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D003558:Cystoscopy / Q000379:methods; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D058994:Salpingectomy / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: cervical cancer; endometrial cancer; laparoscopic staging; minimally invasive comprehensive surgical staging; robotic-assisted laparoscopic staging; same-day discharge