Postanesthesia Care Unit Stay and Complications After Same-Day Discharge Laparoscopic Hysterectomy

Objective: To identify associations between postanesthesia care unit (PACU) length of stay (LOS) and postoperative complications among same-day discharged (SDD) laparoscopic hysterectomy patients. Materials and Methods: A retrospective cohort of women who underwent SDD laparoscopic or robot-assisted hysterectomy by academic minimally invasive gynecologic surgeons between January 2016 and July 2018 were analyzed. Patient preoperative, procedural, and postoperative information were collected. Patients were categorized into short (<2 hour), average (2–4 hour), and long (>4 hour) PACU LOS. Complications were categorized by severity. High-morbidity events were defined as readmissions, reoperations, or emergency department visits. Patient and procedure characteristics by PACU LOS were compared using χ 2 , Fisher's exact, and analysis of variance, where appropriate. Complications among PACU LOS categories were evaluated by unadjusted and multivariable logistic regression. A sensitivity analysis among enhanced recovery after surgery (ERAS)-only patients was done. Results: Of 304 patients, a majority ( n = 185, 60.9%) had average PACU LOS, 81 (26.6%) short LOS, and 38 (12.5%) long LOS. Short PACU LOS was associated with increased odds of high-morbidity events versus average LOS in crude and adjusted models (crude: odds ratio [OR] 2.21; 95% confidence interval [CI] 1.02–4.77; adjusted: OR 2.39; 95% CI 1.07–5.33) and among ERAS-only patients (crude: OR 2.39; 95% CI 1.05–5.46; adjusted: OR 2.36; 95% CI 1.00–5.55). Long PACU LOS was not statistically significantly associated with high-morbidity complications. Conclusions: Short PACU LOS among SDD laparoscopic hysterectomy patients was associated with high-morbidity events. Larger sample size is required to determine whether long PACU LOS is associated with high-morbidity complications.