Extraction Laparotomy for Specimen Retrieval Does Not Alter Same-day Discharge Plans

Study objective: To evaluate whether extraction laparotomy (EL) for intact specimen removal adversely affected the feasibility or safety of same-day discharge (SDD) in patients undergoing minimally invasive surgery (MIS) for confirmed or suspected gynecologic malignancies.

Design: Retrospective study.

Setting: Single-institution study.

Patients: Patients undergoing MIS for gynecologic malignancy at a single institution, who underwent EL (N = 67) and age-matched controls (N = 134).

Interventions: Comparing SDD rates, complications, readmission, and outpatient follow-up after between patients requiring EL and those who did not after minimally invasive gynecologic surgery.

Measurements and main results: A total of 1224 patients were identified. Sixty-seven patients underwent EL for specimen extraction. From the remainder, 134 patients were selected as age-matched controls. SDD rate was 83% (EL) vs 87% (no EL) (p = .39). There was no difference in median pain scores (1.8 vs 1.9 p = .86), length of stay (0 days for both) (p = .41), 30-day readmission rate (6% vs 3%) (p = .45), emergency department visit (13% vs 10%) (p = .76), or any patient contact (34% vs 39%) (p = .53), between the groups. Specimen weight was higher for EL (524 g vs 142 g, p <.001), as was estimated blood loss (104 mL vs 46 mL, p <.001), and surgery time was increased by 22 minutes in the EL group (121 min vs 99 min, p <.001). Patients who underwent EL did require more narcotics in postanesthesia care unit (20.5 vs 12.2 oral morphine equivalent, p = .033); however, this did not translate to increased number of narcotics prescribed at discharge. On logistic regression, a higher specimen weight trended to increase the likelihood of admission (odds ratio, 1.04; confidence interval, 1.01-1.08); however, surgery time, time in postanesthesia care unit, race, body mass index, surgery type, or need for EL did not predict SDD or need for admission.

Conclusion: MIS patients who require EL can still achieve SDD. SDD is safe and feasible without increased risk of readmission, pain score, or unscheduled patient contact postoperatively.