Predictors of same-day discharge after minimally invasive hysterectomy for benign indications

Objective: To identify predictors of same-day discharge after benign minimally invasive hysterectomy. Methods: In this retrospective cohort study, we identified women (n = 1084) undergoing benign minimally invasive hysterectomy from 2009 to 2016. Multivariate logistic regression was used to examine demographic, operative, and surgeon factors associated with discharge on postoperative day 0. Results: In our study population, 238 women (22%) were discharged on the same day. Robotic hysterectomy (risk ratio [RR] 2.24; 95% confidence interval [CI] 1.13–4.44), shorter operative time (lowest quartile; RR 5.28; 95% CI 2.66–10.46), and minimal blood loss (lowest quartile; RR 3.01; 95% CI 1.68–6.23) were associated with higher same-day discharge likelihood whereas later procedure start time (2–5 pm; RR 0.38; 95% CI 0.17–0.85) and postoperative complications (RR 0.19; 95% CI 0.06–0.55) significantly decreased its likelihood. The strongest predictor was surgeon's number of years in practice, with recently graduated surgeons more likely to discharge their patients on the same day (RR 3.15; 95% CI 2.09–4.77). Conclusion: Same-day discharge after minimally invasive hysterectomy is determined by several patient, operative, and surgeon factors that can be incorporated into an implementation plan to promote earlier discharge. Most especially, scheduling patients based on perceived case complexity and targeted surgeon education can qualify a larger cohort for same-day discharge.