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

Enhanced recovery after surgery protocols and the growth of minimally invasive surgery have made same-day discharge increasingly achievable in gynecologic oncology, yet implementation varies and Canadian data remain limited.

We performed a retrospective cohort study of consecutive patients undergoing minimally invasive hysterectomy between 2022 and 2024 who were planned for outpatient management. Demographic and perioperative variables were collected. Failed same-day discharge was defined as unplanned postoperative admission. Descriptive and comparative statistics evaluated predictors of admission or re-admission.

Of 159 minimally invasive hysterectomies, 107 (67.3%) were laparoscopic and 52 (32.7%) were robotic (32.7%). The median patient age was 60 years (IQR 52-67) and median BMI was 30.3 kg/m² (IQR 23.8-35.4). Endometrial cancer was the most common indication (60.5%), followed by adnexal mass (29.0%) and cervical cancer (4.9%). Same-day discharge was achieved in 92.5% of patients, whereas 12 (7.5%) required overnight admission. Half of all cases were simple hysterectomies (complexity = 0), one-third involved a single additional component, and 15% had ≥2 components. Patients who failed same-day discharge had a higher BMI (median 37.0 [IQR 29.8-43.3] vs. 29.9 [IQR 23.5-35.1]; P = 0.006), were more often American Society of Anesthesiologists class 3 (50% vs. 15.6%; P = 0.011), and more frequently arrived in the postoperative care unit after 12 PM (83% vs. 45.9%; P = 0.013).

Same-day discharge after minimally invasive hysterectomy was feasible in over 90% of patients, with low re-admission rates. Higher BMI and American Society of Anesthesiologists class 3 predicted failed discharge and may support preoperative counselling and pathway optimization.