Systematic review of same-day discharge after minimally invasive hysterectomy

Abstract

Background: Same-day discharge has been suggested to safe and acceptable following minimally invasive hysterectomy.

Objectives: To evaluate the feasibility of same-day discharge following minimally invasive hysterectomy and to identify associated factors.

Search strategy: Medline, Embase and the Cochrane Central Register of Controlled Trials were systematically searched using the terms "same day discharge", "minimally invasive surgery", and "hysterectomy" between October 1 and October 31, 2015. No language or publication date restrictions were included.

Selection criteria: Randomized controlled trials and observational studies evaluating same-day discharge before midnight on the day of minimally invasive hysterectomy were included.

Data collection and analysis: Study characteristics, pre-operative selection criteria, and predictive factors for same-day discharge were analyzed.

Main results: There were 15 observational studies with 11 992 patients included. Significant heterogeneity was observed in the studies, and publication and selection bias could have potentially affected the results. All the studies concluded that same-day discharge was feasible. However, some factors were associated with a decreased possibility of same-day discharge; these were older age, beginning surgery later than 1:00 pm and completing surgery later than 6:00 pm, longer duration of operation, and high estimated blood loss.

Conclusions: Same-day discharge appears feasible for a majority of patients who undergo minimally invasive hysterectomies if adequate emphasis is placed on pre-surgical planning and careful patient selection.

Keywords: Gynecologic oncology; Hysterectomy; Laparoscopic; Minimally invasive; Review; Robotic surgery; Same-day discharge.