Data from several studies examining outcomes of outpatient and inpatient laparoscopic hysterectomy found outpatient procedures to be as well tolerated, safe, and effective as inpatient surgery and to be associated with similar or higher levels of patient satisfaction. However, most of these data were obtained from studies with small sample sizes conducted in a single surgical center.
The aim of this retrospective observational study was to compare 30-day postoperative outcomes in outpatient and inpatient laparoscopic hysterectomy surgery as well as overall morbidity, wound complications, medical complications, and repeat operations within 30 days. Data were obtained from more than 250 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Participants were 8846 women who underwent laparoscopic hysterectomy between 2006 and 2010; 3564 of whom were treated as outpatients and 5282 as inpatients. Multivariate logistic regression models were used to control for demographic and operative variables.
Overall morbidity was low for both cohorts. However, there were significantly fewer 30-day complications among outpatients (4.5%) than inpatients (7.2%); P < 0.001. Multivariate analysis showed that outpatients were at significantly lower risk for overall perioperative morbidity; the adjusted odds ratio (aOR) was 0.64 with a 95% confidence interval (CI) of 0.53 to 0.78. Outpatients experienced fewer wound complications (aOR, 0.63; 95% CI, 0.46–0.87; P < 0.005) and were at lower risk for medical complications (aOR, 0.61; 95% CI, 0.49–0.77; P < 0.001). With outpatient surgery, there was a nonsignificant trend toward fewer deep vein thromboses (aOR, 0.61; 95% CI, 0.47–0.80; P < 0.06). An outpatient procedure was not a significant predictor for repeat surgery (aOR, 0.70; 0.46–1.05; P = 0.09).
These findings indicate that outpatient laparoscopic hysterectomy procedures are not associated with increased risk of 30-day morbidity compared with inpatient procedures.
Departments of Surgery (N.K., A.M., and J.Y.S.K.) and Obstetrics and Gynecology (M.P.M.) and Division of Surgical Oncology (K.Y.B.), Northwestern University Feinberg School of Medicine, Chicago, IL