Same-day discharge after minimally invasive hysterectomy for endometrial cancer and endometrial intraepithelial neoplasia in patients with morbid obesity: Safety and potential barriers.

Objective: The goal of this study was to evaluate safety after same-day discharge following minimally invasive hysterectomy for endometrial cancer and endometrial intraepithelial neoplasia in patients with and without morbid obesity (body mass index 40 kg/m). Our secondary objective was to identify barriers to same-day discharge.

Methods: Retrospective cohort study of patients undergoing minimally invasive hysterectomy for endometrial cancer and endometrial intraepithelial neoplasia from January 2016 to May 2022. Complications within 60 days of surgery were reviewed. Of those undergoing same-day discharge, we compared the 60-day complication rates between patients with and without morbid obesity. We compared demographic and clinical characteristics associated with same-day discharge.

Results: 1449 patients underwent minimally invasive hysterectomy during the study period, and 1029 (71%) were discharged the same day. 55 patients (5.3%) experienced a complication after same-day discharge. There was no difference in the frequency of complications between patients with (5.1%) and without (5.4%) morbid obesity (p = .86). Factors associated with not being discharged the same day included older age, higher body mass index, and several co-morbidities (all p < .05). Patients with morbid obesity were twice as likely to stay overnight after controlling for age, comorbidities, and surgical indication (adjusted OR 2.1, 95% CI 1.58 to 2.80).

Conclusion: Despite concerns about the safety of same-day discharge in patients with morbid obesity, 60-day complication rates are not significantly different for this group compared to patients with a body mass index <40 kg/m. Patients with morbid obesity were less likely to be discharged the same day after controlling for confounders.