Same day discharge after hepatectomy: Can it be done safely?

Area of Science:

• Hepatobiliary Surgery
• Surgical Outcomes Research
• Minimally Invasive Surgery

Background:

• Outpatient surgery is expanding due to minimally invasive techniques and enhanced recovery pathways.
• Outpatient hepatectomy (liver surgery) is not yet widely described.
• This study analyzes the feasibility and outcomes of same-day discharge after elective hepatectomy.

Purpose of the Study:

• To determine the incidence and characteristics of patients undergoing outpatient hepatectomy.
• To compare postoperative outcomes between same-day discharge and admitted patients.
• To identify predictors of prolonged postoperative length of stay (LOS) after hepatectomy.

Main Methods:

• Utilized the National Surgical Quality Improvement Program (NSQIP) database (2014-2021).
• Included patients undergoing elective laparoscopic or robotic hepatectomy.
• Defined same-day discharge as discharge on postoperative day 0; compared outcomes using propensity-matched analysis.

Main Results:

• Identified 7279 patients: 361 same-day discharge, 6918 admitted.
• Same-day discharge patients were younger and healthier (lower ASA class, fewer comorbidities).
• No significant differences in 30-day mortality, readmission, or complication rates between groups after matching.

Conclusions:

• Same-day discharge after minimally invasive, elective hepatectomy is feasible for carefully selected, low-risk patients.
• This approach can be performed without compromising patient safety or short-term outcomes.
• Predictors of longer LOS include operative time, inpatient status, transfusion, functional status, and neoadjuvant chemotherapy.