Minimally invasive hysterectomy same-day discharge: systematic review and meta-analysis of predictors.

Abstract

Purpose: Same-day discharge (SDD) is increasingly prevalent following minimally invasive hysterectomy (MIH). However, consensus guidelines for selecting SDD eligibility criteria for MIH remain unexplored. This study aims to identify predictive factors for non-SDD following MIH (registered in PROSPERO CRD42022350373).

Methods: PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. All original studies that involve patients who were discharged on the same day are compared with those who were not (not failure to discharge / not intended to discharge). Categorical and continuous variables were reported as risk ratios with 95% confidence intervals and weighted mean differences with 95% CIs, respectively. Heterogeneity among the included studies was assessed using the I2 statistics. We conducted sensitivity analysis to identify the reason(s) for this heterogeneity.

Results: Ten studies (59,589 patients) were included, with a mean SDD rate of 20.28%. The predictors of overnight observation included factors such as American Society of Anesthesiologists classification (ASA) > II (P = .02; I² = 92%), increased estimated blood loss (EBL) (P < 0.00001; I² = 87%), surgeries starting later in the day (P < 0.00, I² = 15%), and longer operation times (P = .002; I² = 96%). In sensitivity and subgroup analyses, uterus weight emerged as a potential factor (P < 0.00; I² = 50%), while the results concerning ASA, uterine weight, and EBL appeared to be homogeneous. However, the operation time remained heterogeneous.

Conclusion: These factors could assist surgeons in the decision-making process regarding the performance of SDD subsequent to MIH procedures for patients.