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

    Gynecologic oncology, March 2023, 2023-03-00, 20230301, Letnik: 170
    Journal Article

    To determine whether morbid obesity should serve as an independent factor in the decision for same day discharge following minimally invasive hysterectomy. Retrospective review was performed of patients with BMI ≥ 40 who underwent minimally invasive hysterectomy within a single comprehensive cancer center between January 2018 – August 2020. Demographics, perioperative factors, post-operative monitoring, complications, and readmissions were compared between patients who underwent same day discharge and overnight observation using Fisher's exact tests and Wilcoxon rank-sum tests. 374 patients with BMI ≥ 40 were included. Eighty-three (22.2%) patients underwent same day discharge, and 291 (77.8%) patients underwent overnight observation. Factors associated with increased likelihood of same day discharge included younger age (median age 53 vs 58; p = 0.001), lower BMI (median BMI 45 vs 47; p = 0.005), and fewer medical co-morbidities (Charlson Co-Morbidity Index 2 vs 3; p < 0.001). On multivariate regression analysis, frailty (OR 2.16 1.14–4.11, p = 0.019) and surgical completion time after 12 PM (OR 3.67 2.16–6.24, p < 0.001) were associated with increased risk of overnight observation. Few patients admitted for routine overnight observation required medical intervention (n = 14, 4.8%); most of these patients were frail (64.3%). The overall hospital readmission rate within 30 days of discharge was 3.2% (n = 12), with no patients discharged on the day of surgery being readmitted. Morbid obesity alone should not serve as a contraindication to same day discharge following minimally invasive hysterectomy. Admission for observation was associated with low rates of clinically meaningful intervention, and patients who underwent same day discharge were not at increased risk of adverse outcome. •Same day discharge following minimally invasive hysterectomy is generally safe and feasible for morbidly obese patients.•Age, BMI, medical co-morbidities, surgery time and frailty were associated with likelihood of undergoing same day discharge.•Routine overnight observation after minimally invasive hysterectomy led to little clinically meaningful intervention.•Hospital readmission rates are not higher for patients who undergo same day discharge.•A trend toward worse post-operative outcomes was seen in morbidly obese patients who met objective criteria for frailty.