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Published on: January 22, 2022
Enhanced recovery after surgery in minimally invasive hysterectomy for uterine cancer: identifying predictors of
Morgan Bou Zerdan1, Mark F Munsell2, Gavin G Ovsak3
1The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, Texas, USA.
Objective:
Same-day discharge after minimally invasive hysterectomy has become increasingly feasible with the implementation of enhanced recovery after surgery pathways. However, predictors of same-day discharge within standardized enhanced recovery after surgery programs remain incompletely defined. We aimed to identify patient, surgical, and perioperative factors associated with same-day discharge following minimally invasive hysterectomy for uterine cancer at a tertiary cancer center.
Methods:
We conducted a retrospective cohort study of women undergoing minimally invasive hysterectomy for uterine cancer within a standardized enhanced recovery after surgery pathway between January 2020 and December 2024. Demographic, clinical, operative, and enhanced recovery after surgery compliance data were extracted from electronic medical records. Patients were categorized by discharge status (same-day discharge vs non-same-day discharge). Univariable and multi-variable logistic regression analyses were performed to identify predictors of same-day discharge, reporting odds ratios with 95% confidence intervals.
Results:
Among 972 patients, 633 (65%) achieved same-day discharge. In univariable analysis, later surgery start time, older age, higher body mass index, non-Hispanic ethnicity, higher Charlson Comorbidity Index, longer operative time, greater estimated blood loss, and post-operative nausea and vomiting were associated with reduced odds of same-day discharge, while enhanced recovery after surgery compliance was not. In multi-variable analysis, later surgery start time (10:00 AM to 1:59 PM, odds ratio 0.68, 95% confidence interval 0.49 to 0.95, p = .001; 2:00 PM to midnight, odds ratio 0.16, 95% confidence interval 0.11 to 0.24, p < .001), non-Hispanic ethnicity (odds ratio 0.67, 95% confidence interval 0.46 to 0.99, p = .024), higher Charlson Comorbidity Index (odds ratio 0.84, 95% confidence interval 0.77 to 0.92, p < .001), and post-operative nausea and vomiting (odds ratio 0.67, 95% confidence interval 0.49 to 0.90, p = .009) remained independently associated with lower likelihood of same-day discharge.
Conclusions:
Approximately two-thirds of patients achieved same-day discharge following minimally invasive hysterectomy for uterine cancer within an enhanced recovery after surgery pathway. Higher comorbidity burden, post-operative nausea and vomiting, and later surgery start time were key barriers to same-day discharge, highlighting opportunities for improved risk stratification, perioperative symptom management, and surgical scheduling.
