Determinants and Safety of Same-Day Discharge After Robotic Hysterectomy: A Systematic Review and Meta-Analysis

To systematically evaluate perioperative factors associated with discharge timing following robotic hysterectomy (RH) and to assess the safety of same-day discharge (SDD) compared with postoperative admission.

We searched PubMed, Embase, Scopus, the Cochrane Library, and Web of Science from inception to May 2025. Reference lists of included studies were also screened to identify additional relevant publications.

We included cohort studies of women undergoing RH, comparing SDD with postoperative admission. Outcomes of interest included perioperative determinants of SDD and postoperative safety outcomes, including unscheduled postoperative contacts/visits, 30-day readmissions, and reoperations. Two reviewers independently screened titles, abstracts, and full texts. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Data were extracted from ten studies comprising 3200 patients, of whom 1801 were discharged the same day, and 1399 required postoperative admission. A random-effects meta-analysis was conducted in R to calculate mean differences (MD) and odds ratios (ORs) with corresponding 95% confidence intervals. Among preoperative variables, age greater than 75 years, obesity, higher ASA score, and the presence of specific comorbidities, including renal disease, prior venous thromboembolism, and sleep apnea, were associated with lower odds of postoperative SDD. Additional factors linked to decreased likelihood of SDD included a history of prior laparotomy, use of anticoagulant therapy, advanced FIGO stage, high tumor grade, and perioperative anemia. With respect to intraoperative characteristics, concomitant procedures such as bowel or lymph node surgery, mini-laparotomy, conversion to open surgery, prolonged operative duration, late operative start time, and estimated blood loss greater than 200 mL were all associated with a lower probability of achieving SDD. Safety outcomes, including unplanned postoperative contacts or visits, 30-day readmissions, and reoperations, did not significantly differ between the SDD and admission groups.

Same-day discharge after RH appears safe and feasible in appropriately selected patients, particularly younger nonobese individuals with fewer comorbidities, lower disease burden, and those with less extensive procedures. Given that most analyses relied on unadjusted event-level data, identified factors should be interpreted as potential risk indicators rather than definitive causal predictors of SDD. Based on that, while reported safety outcomes appear similar, these results do not imply that SDD is universally as safe as admission, as it is typically applied under specific permitting conditions that may be associated with a lower risk of complications. Future prospective studies using multivariable regression models, as well as randomized controlled trials, are needed to confirm these associations and support evidence-based protocols for SDD following RH.