Predictors of Overnight Admission after Minimally Invasive Hysterectomy in the Expert Setting

Abstract

Study objective: To identify predictors of overnight admission after laparoscopic and robot-assisted hysterectomy to improve preoperative counseling and patient optimization.

Design: A single-center retrospective cohort study (Canadian Task Force classification III).

Setting: Academic university hospital.

Patients: Patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by fellowship-trained minimally invasive gynecologic surgeons for benign indications INTERVENTIONS: Straight-stick laparoscopic and robot-assisted hysterectomy.

Measurements and main results: Data from 396 consecutive minimally invasive hysterectomy procedures were collected for analysis. Three hundred twelve patients (79%) were discharged the same day, and 84 (21%) were admitted for at least 1 night. Data from the 2 groups were compared. Overnight stay compared with same-day discharge was associated with older age (47.3 vs 43.4 years, p < .001), lower preoperation hematocrit (35.8% vs 37.3%, p = .035), history of prior laparotomy (31% vs 14.1%, p = .003), prolonged operative time (190.5 vs 115.2 minutes, p < .001), estimated blood loss (244.6 vs 104.1 mL, p < .001), lysis of adhesion (27.4% vs 13.5%), and intraoperative organ injury (17% vs 3%, p = .005). Logistic regression analysis, adjusting for all included variables as confounders, showed that hematocrit increments of 5% were protective against any overnight stay (odds ratio, .622; p = .015), and a 30-minute increase in operative time increased the odds of an overnight stay by 1.6 (p < .001). History of a laparotomy remained a significant predictive factor for an overnight stay (odds ratio, 3.2; p = .006). Later surgery end time, in 60-minute increments, increased the odds of an overnight stay by 1.2 (p < .01).

Conclusion: Perioperative factors such as age, hematocrit, surgery time, and surgical history as well as intraoperative factors such as prolonged operative time are predictive of overnight hospital stay.

Keywords: Hysterectomy; Minimally invasive hysterectomy; Predictors; Readmission; Reoperation; Safety; Same day discharge.