title: Predictors of 30-day readmission and impact of same-day discharge in laparoscopic hysterectomy.
abstract: OBJECTIVE
  The objective of the study was to identify the predischarge predictors of 30-day readmission and the impact of same-day discharge after laparoscopic hysterectomy.
  
  
  METHODS
  Patients undergoing only laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy participated in the study.
  
  
  RESULTS
  The 30-day readmission rate was 3.1% (277 of 8890). Factors predictive of higher rates of readmission were diabetes (4.4% vs 3.0%; P = .03), chronic obstructive pulmonary disease (8.5% vs 3.1%; P = .02), disseminated cancer (20% vs 3.1%; P < .001), chronic steroid use (7.1% vs 3.1%; P = .03), daily alcohol use of more than 2 drinks (12.5% vs 2.5%; P = .04), and bleeding disorder (10.8% vs 3%; P = .001). Operative factors included surgical time of 2 hours or greater (3.5% vs 2.7%; P = .014). After surgery, patients had a higher rate of readmission when they experienced any 1 or more complications prior to discharge, (6.9% vs 3.1%; P = .01) as well as any complication after discharge (3.6% vs 1.6%; P = .01). Infections (35.7%) and surgical complications (24.2%) were the most common reasons of readmissions. Of these patients, 20.9% were discharged the same day (n = 1855) and had a similar rate of readmission (2.6% vs 3.2%; P = n.s.). Laparoscopic hysterectomy readmission score (LHRS) can be calculated by assigning 1 point to diabetes, chronic obstructive pulmonary disease, disseminated cancer, chronic steroid use, bleeding disorder, length of surgery of 2 hours or longer, and 2 points to any postoperative complication prior to discharge. Readmission rates for the LHRS score were score 1 (2.4%), score 2 (3.3%), score 3 (5.8%), or score 4 (9.5%).
  
  
  CONCLUSIONS
  The overall readmission rate after laparoscopic hysterectomy is low. Patients discharged the same day have similar rates of readmission. Higher LHRS is indicative of higher rates of readmission and may identify a population not suitable for same-day discharge and in need of higher vigilance to prevent readmissions.
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Jennings
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Spencer
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Erin
authors.initials: E
authors.lastname: Medlin
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Laurel W
authors.initials: LW
authors.lastname: Rice
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI. Electronic address: uppal@med.umich.edu.
authors.forename: Shitanshu
authors.initials: S
authors.lastname: Uppal
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D001778:Blood Coagulation Disorders / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D010052:Ovariectomy / Q000379:methods; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012307:Risk Factors; D058994:Salpingectomy / Q000379:methods; D014591:Uterine Diseases / Q000453:epidemiology / Q000601:surgery; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000601:surgery*
chemical_list: D005938:Glucocorticoids
keywords: laparoscopic hysterectomy; readmission; same-day discharge; surgical complications