Same day discharge in minimally invasive surgery for gynaecological cancer

ABSTRACT

Introduction/Background*Same-day discharge (SDD) has been found to be safe and attainable following minimally invasive surgery (MIS) for gynaecological cancer.1 We audited the compliance to SDD, opposed to 24 hours discharge, at the Royal London Hospital.MethodologyWe performed a retrospective audit of all minimally invasive hysterectomies performed at the Royal London Hospital in 2019 and 2020. All patients were identified for SDD at pre-op clinic and were followed up until 30 days post discharge.Data was collected from electronic patient to record demographic, operating time & outcome, postoperative recovery (+/- complication and readmission) and time of discharge.Following the first audit cycle in 2019, interventions were performed comprising of staff education to highlight the human factors that led to failed SDD (including delayed prescriptions, discharge summaries and removal of catheters).Result(s)*A total of 12 patients were selected for SDD in 2020 compared to 22 in 2019 with 30 day follow up for all patients. Numbers of patient in 2020 was reduced due to covid. Successful SDD was achieved in 42% of cases in 2020 compared to 56% in 2019. Of those planned for SDD, 50% of those that failed were due to unavoidable intraoperative complications. No SDD discharges in 2020 failed due to pharmacy, transport or discharge documentation delays (7 failed SDD in 2019 due to these factors). No re-admissions or complications were recorded.Conclusion*Same day discharge continues to be safe and achievable following minimally invasive surgery for gynecological cancer, despite disruption from the Covid-19 pandemic. Auditing and implementation of interventions helps improve this pathway.ReferenceKorsholm M, Mogensen O, Jeppesen MM, Lysdal VK, Traen K, Jensen PT. Systematic review of same-day discharge after minimally invasive hysterectomy. Int J Gynaecol Obstet 2017 Feb;136(2)128–137. doi 10.1002/ijgo.12023. Epub 2016 Nov 11. PMID 28099736.