Factors Influencing Same-day Hospital Discharge and Risk Factors for Readmission After Robotic Surgery in the Gynecologic Oncology Patient Population

Study Objective: To determine the factors that allow for a safe outpatient robotic-assisted minimally invasive gynecologic oncology surgery procedure. Design: Retrospective chart review (Canadian Task Force classification II-1). Setting: University hospital. Patients: All patients (140) undergoing robotic-assisted minimally invasive surgery with the gynecologic oncology service from January 1, 2013, to December 31,2013. Interventions: Risk factors for unsuccessful discharge within 23hours of surgery and same-day discharge were assessed using logistic regression models. Measurements and Main Results: All patients were initially scheduled for same-day discharge. The outpatient surgery group was defined by discharge within 23hours of the surgery end time, and a same-day surgery subgroup was defined by discharge before midnight on the day of surgery. One hundred fifteen (82.1%) were successfully discharged within 23hours of surgery, and 90 (64.3%) were discharged the same day. The median hospital stay was 5.3hours (range, 1-48hours). Unsuccessful discharge within 23hours was associated with a preoperative diagnosis of lung disease and intraoperative complications; unsuccessful same-day discharge was associated with older age and later surgery end time. Only 2 patients (1.4%) were readmitted to the hospital within 30days of surgery. Conclusions: Outpatient robotic-assisted minimally invasive surgery is safe and feasible for most gynecologic oncology patients and appears to have a low readmission rate. Older age, preoperative lung disease, and later surgical end time were risk factors for prolonged hospital stay. These patients may benefit from preoperative measures to facilitate earlier discharge.