Launching a Same-Day Discharge Pathway in Gynecologic Oncology: A Quality-Improvement Experience from Québec

Area of Science:

• Gynecologic Oncology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Enhanced Recovery After Surgery (ERAS) protocols and minimally invasive surgery (MIS) facilitate same-day discharge in gynecologic oncology.
• Implementation of same-day discharge varies, and Canadian data are limited.

Purpose of the Study:

• To evaluate the feasibility and outcomes of same-day discharge after minimally invasive hysterectomy in a Canadian context.
• To identify predictors of failed same-day discharge and unplanned readmission.

Main Methods:

• Retrospective cohort study of 159 patients undergoing minimally invasive hysterectomy (laparoscopic or robotic) planned for outpatient management.
• Data collected included demographics, perioperative variables, and surgical complexity.
• Failed same-day discharge was defined as unplanned postoperative admission; predictors of admission/readmission were analyzed.

Main Results:

• Same-day discharge was achieved in 92.5% of patients (147/159).
• Patients who failed same-day discharge had significantly higher body mass index (BMI) and were more likely to be ASA class 3 or have a later postoperative arrival time.
• Laparoscopic hysterectomy was performed in 67.3% and robotic in 32.7% of cases, with endometrial cancer being the most common indication.

Conclusions:

• Same-day discharge following minimally invasive hysterectomy is a safe and feasible option for the majority of patients, achieving over 90% success.
• Higher BMI and ASA class 3 are significant predictors of failed same-day discharge.
• Preoperative counseling and pathway optimization are recommended for patients with identified risk factors to further improve same-day discharge rates.