Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population
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 und...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | Gynecologic Oncology Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578923000966 |
| _version_ | 1797753972122976256 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Paulina J Haight |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T17:26:43Z |
| format | Article |
| id | doaj.art-9cfe4a2d50724e5d970ea5b6954aed3c |
| institution | Directory Open Access Journal |
| issn | 2352-5789 |
| language | English |
| last_indexed | 2024-03-12T17:26:43Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj.art-9cfe4a2d50724e5d970ea5b6954aed3c2023-08-05T05:16:12ZengElsevierGynecologic Oncology Reports2352-57892023-08-0148101227Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly populationPaulina J Haight0Rachael N Piver1David A Barrington2Jae Baek3Stephen M Graves4Melissa Ardizzone5Jenifer A Akinduro6Audrey C Busho7Deborah Fadoju8Radhika Pandit9Raeshawn Stephens10Lauren M Strowder11Shreekari Tadepalli12Brianna VanNoy13Bhargavi Sriram14Eric M McLaughlin15Michelle DS Lightfoot16Laura M Chambers17Kristin L Bixel18David E Cohn19Casey M Cosgrove20David O'Malley21Ritu Salani22Floor J Backes23Christa I Nagel24Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA; Corresponding authors at: M-210 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH 43210, USA.Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USADepartment of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USAThe Ohio State University College of Medicine, Columbus, OH, USACenter for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USADivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USAObjective: 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.http://www.sciencedirect.com/science/article/pii/S2352578923000966Minimally invasive hysterectomySame-day dischargeElderlyFrailty |
| spellingShingle | 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 Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population Gynecologic Oncology Reports Minimally invasive hysterectomy Same-day discharge Elderly Frailty |
| title | Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population |
| title_full | Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population |
| title_fullStr | Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population |
| title_full_unstemmed | Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population |
| title_short | Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population |
| title_sort | assessment of the feasibility of same day discharge following minimally invasive hysterectomy in the elderly population |
| topic | Minimally invasive hysterectomy Same-day discharge Elderly Frailty |
| url | http://www.sciencedirect.com/science/article/pii/S2352578923000966 |
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