Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population

Paulina J Haight; Rachael N Piver; David A Barrington; Jae Baek; Stephen M Graves; Melissa Ardizzone; Jenifer A Akinduro; Audrey C Busho; Deborah Fadoju; Radhika Pandit; Raeshawn Stephens; Lauren M Strowder; Shreekari Tadepalli; Brianna VanNoy; Bhargavi Sriram; Eric M McLaughlin; Michelle Ds Lightfoot; Laura M Chambers; Kristin L Bixel; David E Cohn; Casey M Cosgrove; David O'Malley; Ritu Salani; Floor J Backes; Christa I Nagel

doi:10.1016/j.gore.2023.101227

Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population

Gynecol Oncol Rep. 2023 Jun 19:48:101227. doi: 10.1016/j.gore.2023.101227. eCollection 2023 Aug.

Authors

Paulina J Haight¹, Rachael N Piver², David A Barrington¹, Jae Baek³, Stephen M Graves², Melissa Ardizzone³, Jenifer A Akinduro³, Audrey C Busho³, Deborah Fadoju³, Radhika Pandit³, Raeshawn Stephens³, Lauren M Strowder³, Shreekari Tadepalli³, Brianna VanNoy³, Bhargavi Sriram³, Eric M McLaughlin⁴, Michelle Ds Lightfoot¹, Laura M Chambers¹, Kristin L Bixel¹, David E Cohn¹, Casey M Cosgrove¹, David O'Malley¹, Ritu Salani¹, Floor J Backes¹, Christa I Nagel¹

Affiliations

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA.
² Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
³ The Ohio State University College of Medicine, Columbus, OH, USA.
⁴ Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA.

Abstract

Objective: To determine the safety and feasibility of same-day discharge (SDD) following minimally invasive hysterectomy (MIH) for elderly patients and to evaluate associations between age, frailty, and postoperative outcomes.

Methods: Retrospective review was conducted of patients aged ≥ 70 who underwent MIH within a single gynecologic oncology institution from 2018 to 2020. Demographics, peri-operative factors, postoperative complications, and 30-day readmission rates were collected. Frailty was determined by an 11-point modified frailty index ≥ 2. Outcomes were compared between SDD and observation groups using Fisher's exact and Wilcoxon rank-sum tests.

Results: Of 169 patients included in the analysis, 8.9% (n = 15) underwent SDD, and 91.1% (n = 154) were admitted for OBS following MIH. Demographics, peri-operative factors, and frailty rates (33% SDD vs 43.5% observation; p = 0.59) were similar between groups. 86.7% (n = 13) of SDD cases were completed before 12PM, and none were completed after 6PM. No SDD patients had early post-operative complications or hospital readmissions. Early postoperative complications were diagnosed in 9 (5.8%) patients admitted for OBS, and the 30-day hospital readmission rate for patients who underwent OBS was 8.4% (n = 13). While elderly patients who met objective frailty criteria (n = 72) did not have a higher likelihood of early post-operative complications (44.4% vs 55.6%; p = 0.909), they did have a higher likelihood of ED visit within 30 days of discharge (15.3 vs 3.1%; p = 0.009), and a trend was noted toward a higher rate of 30-day hospital readmission (12.5% vs 4.1%; p = 0.080).

Conclusions: Elderly patients undergoing SDD following MIH did not have increased morbidity or mortality. Elderly patients who meet objective criteria for frailty, however, represent a more vulnerable population.

Keywords: Elderly; Frailty; Minimally invasive hysterectomy; Same-day discharge.