Variables impacting prolonged post-anesthesia care unit length of stay in gynecologic cancer patients in the era of same day minimally invasive hysterectomy

• Published in: Gynecologic oncology Vol. 186; pp. 211 - 215
• Main Authors: Flanigan, Margaret R., Bell, Sarah G., Donovan, Heidi S., Zhao, Jian, Holder-Murray, Jennifer M., Esper, Stephen A., Ficerai-Garland, Gabriella, Taylor, Sarah E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Adult; Aged; Anesthesia Recovery Period; Female; Genital Neoplasms, Female - surgery; Gynecologic cancer; Hospital admission; Humans; Hysterectomy - methods; Hysterectomy - statistics & numerical data; Length of Stay - statistics & numerical data; Middle Aged; Minimally invasive hysterectomy; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - statistics & numerical data; Post-operative length of stay; Retrospective Studies; Risk Factors; Post-operative length of stay; Minimally invasive hysterectomy; Gynecologic cancer; Hospital admission
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2024.05.033

Minimally invasive surgery for treatment of gynecologic malignancies is associated with decreased pain, fewer complications, earlier return to activity, lower cost, and shorter hospital stays. Patients are often discharged the day of surgery, but occasionally stay overnight due to prolonged post-anesthesia care unit (PACU) stays. The objective of this study was to identify risk factors for prolonged PACU length of stay (LOS). This is a single institution retrospective review of patients who underwent minimally invasive hysterectomy for gynecologic cancer from 2019 to 2022 and had a hospital stay <24-h. The primary outcome was PACU LOS. Demographics, pre-operative diagnoses, and surgical characteristics were recorded. After Box-Cox transformation, linear regression was used to determine significant predictors of PACU LOS. For the 661 patients identified, median PACU LOS was 5.04 h (range 2.16–23.76 h). On univariate analysis, longer PACU LOS was associated with increased age (ρ = 0.106, p = 0.006), non-partnered status [mean difference (MD) = 0.019, p = 0.099], increased alcohol use (MD = 0.018, p = 0.102), increased Charlson Comorbidity Index (CCI) score (ρ = 0.065, p = 0.097), and ASA class ≥3 (MD = 0.033, p = 0.002). Using multivariate linear regression, increased age (R2 = 0.0011, p = 0.043), non-partnered status (R2 = 0.0389, p < 0.001), and ASA class ≥3 (R2 = 0.0250, p = 0.023) were associated with increased PACU LOS. Identifying patients at risk for prolonged PACU LOS, including patients who are older, non-partnered, and have an ASA class ≥3, may allow for interventions to improve patient experience, better utilize hospital resources, decrease PACU overcrowding, and limit postoperative admissions and complications. The relationship between non-partnered status and PACU LOS is the most novel relationship identified in this study. •Minimally invasive surgery (MIS) is standard of care for many gynecologic cancers and often results in same day discharge.•Prolonged post-anesthesia care unit (PACU) length of stay (LOS) may contribute to unplanned admissions after MIS.•Factors that impact PACU LOS after MIS, distinct from hospital length of stay, are largely unknown.•Age, partner status, alcohol use, CCI score, and ASA class are associated with PACU LOS on univariate analysis.•Older age, non-partnered status, and ASA class ≥3 are associated with increased PACU LOS on multivariate analysis.