Research Shows Same‐day Discharge Following Laparoscopic Hysterectomy Safe and Acceptable

   Same‐day discharge of laparoscopic hysterectomy is a safe and acceptable alternative to admission, according to research presented at the American College of Obstetricians and Gynecologists' 58th Annual Clinical Meeting in San Francisco.

   Many gynecologic surgeons who perform laparoscopic hysterectomies admit their patients for one or two days; however, a growing number are practicing same‐day discharge. To date, there have been no large studies examining the safety of this practice. Miya P. Yamamoto, MD, and colleagues at Kaiser Permanente East Bay in Oakland, California, conducted a retrospective cohort study including all same‐day discharge laparoscopic hysterectomy patients from Northern and Southern California Kaiser Permanente from 2005 through 2008. The primary outcome of this study was hospital readmission rates for up to one year postoperatively. Referencing available large studies on open hysterectomy and expert opinion, a readmission rate of less than 6% was determined to be acceptable. Secondary outcomes included emergency room visits, urgent appointments, postoperative complications, operative time, blood loss, and transfusion rates. Bivariate and multivariate analyses were performed to examine outcomes and potential risk factors.

   Preliminary analysis of an initial cohort of 1900 patients demonstrated a readmission rate of less than 5% and an emergency room visit rate of 5%. The estimated blood loss was less than 150 mL, and  complication rates were minimal. The researchers concluded that same‐day discharge of laparoscopic hysterectomy is a safe and acceptable alternative to admission, thus reducing the overall hospital and health care burden.

   In other research presented at the meeting, researchers from the Atlanta Center for Special Minimally Invasive Surgery & Reproductive Medicine in Georgia showed that 5‐mm daVinci ports and instruments can be used effectively in the laparoscopic treatment of endometriosis. They found that the smaller port size provides the benefit of smaller incisions, along with reduced risk of incisional pain and hernias. The smaller instrumentation may be advantageous in the treatment of endometriosis where detailed dissection and manipulation is required, the researchers said.