title: Predictors of early discharge after open gynecological surgery in the setting of an enhanced recovery after surgery protocol.
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) protocols have been proven to decrease length of hospital stay without increasing readmission rates or complications. However, patient and operative characteristics that improve the chance of successful early hospital discharge are unknown. The aim of this study was to determine the characteristics of patients undergoing open gynecological surgery in an ERAS protocol who could be discharged home by postoperative day 3.
  
  
  METHODS
  A retrospective review was performed on patients undergoing laparotomy by a single surgeon and managed by an ERAS protocol between January 2008 and April 2013. Data collection on patient characteristics, hospitalization and post-discharge details was performed prospectively. Patients successfully discharged home on or by day 3 (early discharge) were compared to patients who had a longer admission (late discharge).
  
  
  RESULTS
  During the study period, 454 consecutive patients were identified and included in the study. No patients were excluded. A total of 335 patients (73.8%) were successfully discharged home within 3 days. After adjusting for age and Eastern Cooperative Oncology Group performance score, patients with early discharge were significantly less likely to have a malignancy (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.36-0.97; P = 0.038), intensive care unit admission (OR, 0.59; 95%CI, 0.36-0.97; P = 0.046), vertical midline incision (OR, 0.28; 95%CI, 0.07-0.82), complications (OR, 0.21; 95%CI, 0.09-0.49; P = 0.0003), or FIGO Stage III or IV disease (OR, 0.39; 95%CI, 0.23-0.67; P = 0.001). Prior abdominal surgery, body mass index > 25 and lymph node dissection did not significantly influence length of hospital stay.
  
  
  CONCLUSIONS
  Malignancy, advanced-stage disease, intensive care unit admission, vertical midline incision and perioperative complications are significantly associated with longer hospital stay in patients managed by an ERAS protocol.
authors.affiliation: Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse and Royal Prince Alfred Hospital, Sydney, Australia. kingmanwan@gmail.com.
authors.forename: King Man
authors.initials: KM
authors.lastname: Wan
authors.affiliation: Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse and Royal Prince Alfred Hospital, Sydney, Australia.|The University of Sydney, Sydney, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
authors.affiliation: Lifehouse Gynaecological Oncology Group, Chris O'Brien Lifehouse and Royal Prince Alfred Hospital, Sydney, Australia.|The University of Sydney, Sydney, Australia.
authors.forename: Shannon
authors.initials: S
authors.lastname: Philp
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care; D059035:Perioperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: enhanced recovery; fast track; gynecology; length of stay; perioperative care