Promoting Same-Day Discharge for Gynecologic Oncology Patients in Minimally Invasive Hysterectomy

2017 ◽  
Vol 24 (6) ◽  
pp. 932-939 ◽  
Author(s):  
Cynthia R. Fountain ◽  
Laura J. Havrilesky
Keyword(s):  
Minimally Invasive ◽  
Gynecologic Oncology ◽  
Oncology Patients ◽  
Same Day Discharge ◽  
Minimally Invasive Hysterectomy

Opioid use after minimally invasive hysterectomy in gynecologic oncology patients

2019 ◽  
Vol 155 (1) ◽  
pp. 119-125 ◽  
Author(s):  
Erica Weston ◽  
Christina Raker ◽  
David Huang ◽  
Ashley Parker ◽  
Michael Cohen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gynecologic Oncology ◽  
Opioid Use ◽  
Oncology Patients ◽  
Minimally Invasive Hysterectomy

Factors Associated With Unplanned Admission in Patients Intended for Same Day Discharge After Minimally Invasive Hysterectomy for Endometrial Cancer

2021 ◽  
pp. 155335062110418
Author(s):  
Ji Son ◽  
Thang Tran ◽  
Meng Yao ◽  
Chad M. Michener
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Operative Time ◽  
Gynecologic Oncology ◽  
Multivariable Analysis ◽  
Unplanned Admission ◽  
Pain Scores ◽  
Same Day Discharge ◽  
Comorbidity Index ◽  
Minimally Invasive Hysterectomy

Objectives. To identify factors that lead to successful same-day discharge compared with unplanned and planned admission after minimally invasive hysterectomy for endometrial cancer. Methods. Patients undergoing laparoscopic or robotic hysterectomy for endometrial cancer between 2016 and 2019 were retrospectively reviewed. 3 groups were created: same-day discarge (SDD), unplanned admission (UA), and planned admission(PA). Demographic/perioperative factors and encounters after discharge were compared. A multivariable logistic regression was performed. Results. 262 patients were included. By year, the success of SDD increased from 59.1% to 82.5%. Patients who underwent SDD compared with admission were younger (62.2 vs 66.2, P = .003) and had a lower Charlson Comorbidity Index (4 vs 5, P < .001). BMI was not significant. Comparing SDD and UA, shorter operative time (100.3 min vs 130.6 min, P = .037) was associated with SDD. Postoperative pain scores were not significant (3.8 vs 4.7, P = .086). The rate of unscheduled encounters within 30 days of discharge was not significantly different. On multivariable analysis, the odds of SDD decreased by 4% with each 1-year increase in age (OR .96, P = .017). Each 1-minute increase in operative time decreased the odds of SDD by 2% (OR .98, P < .001). Intraoperative acetaminophen (OR 2.78, P = .003) and ketorolac (OR 2.27, P = .031) were predictive of SDD. Conclusion. SDD can be safely incorporated into clinical practice in gynecologic oncology patients undergoing minimally invasive hysterectomy, even for patients older than previously reported. Shorter operative time was associated with SDD. The role of perioperative acetaminophen and ketorolac should be further investigated.

Enhanced recovery after minimally invasive gynecologic oncology surgery to improve same day discharge: a quality improvement project

2022 ◽  
pp. ijgc-2021-003065
Author(s):  
Soyoun Rachel Kim ◽  
Stephane Laframboise ◽  
Gregg Nelson ◽  
Stuart A McCluskey ◽  
Lisa Avery ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Quality Improvement ◽  
Minimally Invasive ◽  
Gynecologic Oncology ◽  
Emergency Department Visits ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Improvement Project ◽  
Same Day Discharge ◽  
Minimally Invasive Hysterectomy

ObjectivesSame day discharge after minimally invasive hysterectomy has been shown to be safe and feasible. We designed and implemented a quality improvement perioperative program based on early recovery after surgery principles to improve the rate of same day discharge from 30% to 75% after minimally invasive gynecologic oncology surgery over a 12 month period.MethodsWe enrolled 102 consecutive patients undergoing minimally invasive hysterectomy at a single cancer center during a 12 month period. A pre-intervention cohort of 100 consecutive patients was identified for comparison of clinicodemographic variables and perioperative outcomes. A multidisciplinary team developed a comprehensive perioperative care program and followed quality improvement methodology. Patients were followed up for 30 days after discharge. A statistical process chart was used to monitor the effects of our interventions, and a multivariate analysis was conducted to determine factors associated with same day discharge.ResultsSame day discharge rate increased from 29% to 75% after implementation (p<0.001). The post-intervention cohort was significantly younger (59 vs 62 years; p=0.038) and had shorter operative times (180 vs 211 min; p<0.001) but the two groups were similar in body mass index, comorbidity, stage, and intraoperative complications. There was no difference in 30 day perioperative complications, readmissions, reoperations, emergency department visits, or mortality. Overnight admissions were secondary to nausea and vomiting (16%), complications of pre-existing comorbidities (12%), and urinary retention (8%). On multivariate analysis, longer surgery, timing of surgery, and narcotic use on the ward were significantly associated with overnight admission. Overall, 89% of patients rated their experience as ‘very good’ or ‘excellent’, and 87% felt that their length of stay was adequate.ConclusionsFollowing implementation of a perioperative quality improvement program targeted towards minimally invasive gynecologic oncology surgery, our intervention significantly improved same day discharge rates while maintaining a low 30 day perioperative complication rate and excellent patient experience.

The association between mindfulness and post-operative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10079-10079 ◽  
Author(s):  
Erica Weston ◽  
Christina Raker ◽  
David Huang ◽  
Cara Amanda Mathews
Keyword(s):  
Minimally Invasive ◽  
Rating Scale ◽  
Gynecologic Oncology ◽  
Personality Characteristic ◽  
Gynecologic Surgery ◽  
Five Facet Mindfulness Questionnaire ◽  
Oncology Patients ◽  
Post Operative Pain ◽  
Pain Outcomes ◽  
Minimally Invasive Hysterectomy

10079 Background: Studies demonstrate an inverse relationship between mindfulness and chronic pain. However, the relationship between mindfulness and acute post-operative pain has not yet been thoroughly investigated. The objective of this study is to determine if there is an association between pre-operative level of mindfulness and post-operative pain outcomes in women undergoing minimally invasive hysterectomy. Methods: For this prospective cohort study, women planning to undergo laparoscopic or robotic hysterectomy were prospectively recruited at the gynecologic oncology outpatient clinic at our institution. Baseline mindfulness was assessed at the pre-operative clinic visit using the Five Facet Mindfulness Questionnaire (FFMQ). Post-operative pain, using the Visual Numeric Rating Scale (VNRS-11), and opiate pain medication usage were evaluated via chart review and post-operative surveys completed at 1 to 2 week and 4 to 6 week post-operative clinic visits. Results: One hundred twenty four women completed the 6 week post-operative follow-up period, of which 80% were undergoing surgery for malignancy. Baseline mindfulness was inversely correlated with post-operative pain as measured by both the average and highest reported VNRS-11 values during the inpatient stay (r = -0.21, p = 0.019; r = -0.21, p = 0.016). At the 1 to 2 week post-operative visit, self-reported pain score was also inversely correlated with pre-operative mindfulness score (r = -0.24, p = 0.009). This relationship was not observed at the 4 to 6 week post-operative visit (r = -0.08, p = 0.403). Higher pre-operative mindfulness was also associated with lower opiate usage (r = -0.16, p = 0.077), though this relationship was not statistically significant. Conclusions: Higher pre-operative mindfulness is associated with more favorable post-operative pain outcomes, including lower reported numeric pain scores, in gynecologic oncology patients undergoing minimally invasive hysterectomy. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to improve post-operative pain in women planning gynecologic surgery.

Impact of inpatient hospitalization on opiate usage for minimally invasive hysterectomy amongst gynecologic oncology patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18109-e18109
Author(s):  
Amy Dawn Gee ◽  
Shannon Michelle Grabosch ◽  
Jeffrey Gavard
Keyword(s):  
Minimally Invasive ◽  
Gynecologic Oncology ◽  
Hospitalized Patients ◽  
Categorical Variables ◽  
Psychiatric Disease ◽  
Same Day Discharge ◽  
The Impact ◽  
Minimally Invasive Hysterectomy ◽  
Chronic Use ◽  
At Home

e18109 Background: The overdose death rate related to opiates has quadrupled in the last two decades. Up to 27% of chronic opiate users report initiation in the post-op period. Among cancer patients, 10% of opioid-naive patients continue chronic use one year after surgery. Restrictive opiate prescribing has demonstrated promise in other studies. However, lacking from current literature is an analysis of the effect that same day discharge (SDD) has on post-op opiate usage at home. The objective of this study is to evaluate the impact of SDD versus physician-elected observation for 1 to 2 days on acute post-op opiate usage and safety following minimally-invasive hysterectomy (MIH). Methods: This is a prospective observational study of women undergoing MIH. Sixty patients were assigned to either the SDD or hospitalization group at provider discretion based on practice pattern, distance from hospital, or comorbidities. One patient was lost to follow up. Patients were followed through 30 days after surgery. Total opiate usage included the inpatient usage (if hospitalized) and home usage assessed at the post-op visit. Anonymous surveys were used to collect home opiate usage practices, satisfaction, and self-reported risk factors for continued use. Continuous variables were analyzed by independent Student’s t-test and the Mann-Whitney U test. Categorical variables were analyzed using Chi-square test and Fisher's Exact test. Results: 29 SDD and 30 hospitalized patients were available for review. Demographics including age, BMI, tobacco use, and procedure indication were well matched. SDD patients used a median 5.0 (1.5-13.5) versus 8.5 (2.25-14.25) 5mg oxycodone tabs (p 0.33). SDD patients used opiates less for non-pain indications including to sleep (4 vs 9, p 0.24) or relax (3 vs 5, p 0.71). One SDD patient had a complication of a cuff hematoma, which spontaneously drained. There were no readmissions. Only one SDD patient felt she would have benefited from longer stay due to nausea. All hospitalized patients took their own opiates at home while 7 SDD had a family member dispense. Psychiatric disorders were the highest comorbidities in both groups (depression n = 12 and 10, anxiety n = 10 and 12). Conclusions: SDD demonstrated a trend towards less opiate usage, although not statistically significant. Patients did not feel that they needed to stay longer in the hospital. The safety of SDD is supported by lack of readmissions and one minor post-op complication. The high rates of psychiatric disease are a concerning risk factor for chronic use.

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