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Same-Day Discharge Safe in Lap. Hysterectomy


 

From the Annual Meeting of the American College of Obstetricians and Gynecologists

Major Finding: Among 287 patients who underwent supracervical laparoscopic hysterectomy, only 0.7% were readmitted within 48 hours, and 3.4% within 3 months. Among 241 patients who underwent total laparoscopic hysterectomy, only 0.4% were readmitted within 48 hours, and 4.1% within 3 months.

Data Source: Retrospective case series of all women undergoing a laparoscopic hysterectomy for benign indications, performed by ob.gyn. generalists.

Disclosures: None was reported.

SAN FRANCISCO — Only 0.6% of 528 women who were discharged from the hospital the same day that they underwent a laparoscopic hysterectomy were readmitted within 48 hours, and 3.8% were readmitted within 3 months, results of a retrospective study found.

Using previous large studies on hysterectomies as a reference, any readmission rate less than 6% could be considered acceptable, and readmission rates in the current study were significantly lower than that, Dr. Miya Yamamoto reported in a prize-winning poster. Same-day discharge after laparoscopic hysterectomy appears to be safe, and could significantly decrease costs and health care use by eliminating postprocedure hospital stays, she and her colleagues said.

Hysterectomy is the most common gynecologic surgery in the United States, and an increasing number are being performed laparoscopically. No previous large studies have evaluated the safety of same-day discharge after laparoscopic hysterectomy. Many patients are admitted for an overnight hospital stay after the procedure, but a growing number are discharged on the same day, they said.

Dr. Yamamoto of Oakland, Calif., and her associates at Kaiser Permanente Northern California studied records on women at their institutions who underwent a laparoscopic hysterectomy for benign indications in 2007-2009 and were discharged the same day. The surgeries were performed by generalists in ob.gyn. and included 287 supracervical laparoscopic hysterectomies and 241 total laparoscopic hysterectomies. Overall, 1.5% had urgent clinic visits after their hysterectomy and discharge. Four percent visited the emergency department within 48 hours of the procedure, mainly for nausea or vomiting, urinary retention, or pain.

Of patients who underwent supracervical laparoscopic hysterectomy, 0.7% were readmitted within 48 hours, and 3.4% within 3 months. In those who underwent total laparoscopic hysterectomy, 0.4% were readmitted within 48 hours, and 4.1% within 3 months. The two subgroups did not differ significantly in any outcomes.

Records from the hysterectomies showed a mean operating time of 157 minutes, a median estimated blood loss of 50 mL, and a mean uterine weight of 222 g. Hysterectomies were performed because of fibroids in 46% of patients, for menorrhagia in 27%, for pain in 15%, and for other reasons in 12%.

Patients in the current study had a median age of 45 years and a median body mass index of 28 kg/m

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