Background
Same-day discharge following minimally invasive hysterectomy has been shown to be
safe and feasible in select populations, but many nonclinical factors influencing
same-day discharge remain unexplored.
Objective
To develop prediction models for same-day discharge following minimally invasive hysterectomy
using both clinical and nonclinical attributes and to compare model concordance of
individual attribute groups.
Study Design
We performed a retrospective study of patients who underwent elective minimally invasive
hysterectomy for benign gynecologic indications at 69 hospitals in a statewide quality
improvement collaborative between 2012 and 2019. Potential predictors of same-day
discharge were determined a priori and placed into 1 of 7 attribute groupings: intraoperative,
surgeon, hospital, surgical timing, patient clinical, patient socioeconomic, and patient
geographic attributes. To account for clustering of same-day discharge practices among
surgeons and within hospitals, hierarchical multivariable logistic regression models
were fitted using predictors from each attribute group individually and all predictors
in a composite model. Receiver operator characteristic curves were generated for each
model. The Hanley–McNeil test was used for comparisons, 95% confidence intervals for
the areas under the receiver operator characteristic curve were calculated, and a
P value of <.05 was considered significant.
Results
Of the 23,513 patients in our study, 5062 (21.5%) had same-day discharge. The composite
model had an area under the receiver operator characteristic curve of 0.770 (95% confidence
interval, 0.763–0.777). Among models using factors from individual attribute groups,
the model using intraoperative attributes had the highest concordance for same-day
discharge (area under the receiver operator characteristic curve, 0.720; 95% confidence
interval, 0.712–0.727). The models using surgeon and hospital attributes were the
second and third most concordant, respectively (area under the receiver operator characteristic
curve, 0.678; 95% confidence interval, 0.670–0.685; area under the receiver operator
characteristic curve, 0.655; 95% confidence interval, 0.656–0.664). Models using surgical
timing and patient clinical, socioeconomic, and geographic attributes had poor predictive
ability (all areas under the receiver operator characteristic curve <0.6).
Conclusion
Clinical and nonclinical attributes contributed to a composite prediction model with
good discrimination in predicting same-day discharge following minimally invasive
hysterectomy. Factors related to intraoperative, hospital, and surgeon attributes
produced models with the strongest predictive ability. Focusing on these attributes
may aid efforts to improve utilization of same-day discharge following minimally invasive
hysterectomy.
Key words
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References
- Hysterectomy rates in the United States, 2003.Obstet Gynecol. 2007; 110: 1091-1095
- Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women.Am J Obstet Gynecol. 2018; 218: 425.e1-425.e18
- Same-day discharge after laparoscopic hysterectomy.Obstet Gynecol. 2011; 117: 1136-1141
- Systematic review of same-day discharge after minimally invasive hysterectomy.Int J Gynaecol Obstet. 2017; 136: 128-137
- Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care.J Minim Invasive Gynecol. 2009; 16: 581-588
- Implementation of a same-day discharge protocol following total laparoscopic hysterectomy.J Obstet Gynaecol Can. 2018; 40: 29-35
- Total laparoscopic hysterectomy and early discharge: satisfaction and feasibility study.J Minim Invasive Gynecol. 2008; 15: 20-25
- Outpatient vaginal hysterectomy is safe for patients and reduces institutional cost.J Minim Invasive Gynecol. 2005; 12: 494-501
- Clinical outcomes after fast-track care in women undergoing laparoscopic hysterectomy.Int J Gynaecol Obstet. 2015; 131: 301-304
- Factors influencing same-day hospital discharge and risk factors for readmission after robotic surgery in the gynecologic oncology patient population.J Minim Invasive Gynecol. 2015; 22: 219-226
- The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications.Gynecol Oncol. 2014; 133: 552-555
- Predictors of same-day discharge after minimally invasive hysterectomy for benign indications.Int J Gynaecol Obstet. 2021; ([Epub ahead of print])
- Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative.Am J Obstet Gynecol. 2016; 214: 259.e1-259.e8
- MSJAMA. Relationship Between travel distance and utilization of breast cancer treatment in rural northern Michigan.JAMA. 2002; 287: 111
- The association between distances traveled for care and treatment choices for pelvic floor disorders in a rural southwestern population.J Health Dispar Res Pract. 2014; 7: 23-32
- Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies.Am J Obstet Gynecol. 2015; 212: 186.e1-186.e8
- The volume-outcome paradigm for gynecologic surgery: clinical and policy implications.Clin Obstet Gynecol. 2020; 63: 252-265
- The impact of surgeon volume on perioperative outcomes in hysterectomy.JSLS. 2014; 18: 174-181
- Effect of surgical volume on outcomes for laparoscopic hysterectomy for benign indications.Obstet Gynecol. 2012; 119: 709-716
- Outcomes of hysterectomy performed by very low-volume surgeons.Obstet Gynecol. 2018; 131: 981-990
- Risk factors and outcomes for conversion to laparotomy of laparoscopic hysterectomy in benign gynecology.Obstet Gynecol. 2016; 128: 1295-1305
- Impact of hospital volume on operative mortality for major cancer surgery.JAMA. 1998; 280: 1747-1751
- Hospital volume and surgical mortality in the United States.N Engl J Med. 2002; 346: 1128-1137
- Same-day discharge after laparoscopic hysterectomy for endometrial cancer.Ann Surg Oncol. 2016; 23: 178-185
- Historical and forecasted changes in utilization of same-day discharge after minimally invasive hysterectomy.J Minim Invasive Gynecol. 2022; ([Epub ahead of print])
Article info
Publication history
Published online: May 13, 2022
Accepted:
May 10,
2022
Received in revised form:
May 6,
2022
Received:
January 3,
2022
Footnotes
The authors report no conflict of interest.
Salary support for N.S.K. and D.M.M. is provided by Blue Cross Blue Shield of Michigan. C.X.H. has no relevant financial disclosures to report.
The authors have no sources of funding to report.
Randomized Clinical Trial Status: This study is not a randomized clinical trial.
Cite this article as: Hong CX, Kamdar NS, Morgan DM. Predictors of same-day discharge following benign minimally invasive hysterectomy. Am J Obstet Gynecol 2022;227:320.e1-9.
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