Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies.
Autor: | Penner KR; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Irvine Medical Center, Orange, CA., Fleming ND; Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX., Barlavi L; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA., Axtell AE; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA., Lentz SE; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA. Electronic address: scott.e.lentz@kp.org. |
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Jazyk: | angličtina |
Zdroj: | American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2015 Feb; Vol. 212 (2), pp. 186.e1-8. Date of Electronic Publication: 2014 Aug 14. |
DOI: | 10.1016/j.ajog.2014.08.010 |
Abstrakt: | Objective: The objective of the study was to evaluate the feasibility and safety of same-day discharge of patients undergoing minimally invasive comprehensive surgical staging for endometrial and cervical cancer. Study Design: We performed a retrospective review of consecutive patients from January 2008 to December 2011 undergoing comprehensive staging for endometrial or cervical cancer by traditional laparoscopy or robotic-assisted laparoscopy and intended for same-day discharge. Patients accomplishing same-day discharge were compared with those who required admission. Clinical and demographic data, perioperative outcomes, and postoperative patient contacts within 6 weeks were collected. Multivariate logistic regression modeling was used to determine factors associated with admission and unscheduled patient contacts within 2 weeks of surgery. Results: A total of 141 patients were identified. One hundred eighteen patients (83.7%) underwent same-day discharge and 23 (16.3%) required overnight admission. The variables that significantly predicted overnight admission were severe pain in the postanesthesia care unit (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.74-26.6; P = .006), delayed ability to tolerate oral intake (OR, 9.3; 95% CI, 2.25-38.6, P = .002), traditional laparoscopic vs robotic-assisted surgical approach (OR, 9.05; 95% CI, 2.34-35.1; P = .001), and surgery start time at 2:00 pm or later (OR, 36.8; 95% CI, 6.19-219.3; P < .0001). There was no difference in the readmission rate between patients undergoing same-day discharge compared with overnight admission (11% vs 17%, P = .48). No variables significantly predicted unscheduled patient contact within 2 weeks of surgery at P < .01. Conclusion: Same-day discharge for patients undergoing laparoscopic or robotic-assisted laparoscopic staging for endometrial or cervical cancer is feasible and safe. There are low complication rates and few readmissions or unscheduled patient contacts within 2 weeks of surgery. (Copyright © 2015 Elsevier Inc. All rights reserved.) |
Databáze: | MEDLINE |
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