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 chi(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.