Comparison of Perioperative Outcomes in Outpatient and Inpatient Laparoscopic Hysterectomy

Study Objective: To compare 30-day postoperative outcomes in outpatient and inpatient laparoscopic hysterectomy procedures. Design: Retrospective observational study (Canadian Task Force classification II-2). Setting: More than 250 hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program. Patients: Women undergoing laparoscopic hysterectomy between 2006 and2010. Intervention: Of 8846 patients, 3564 underwent treatment as outpatients, as defined by hospital billing. Measurements and Main Results: Overall morbidity was low in both cohorts; however, significantly fewer 30-day complications were observed in outpatients (4.5%) than inpatients (7.2%) (p <.001). Individual medical and wound complications were also rare and were less common in outpatients whenever a significant difference existed. After adjusting for demographic and operative variables, multivariate regression models found outpatients to be at significantly lower risk for overall perioperative morbidity (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.53-0.78). Outpatients were less likely to experience wound complications (OR, 0.63; 95% CI, 0.46-0.87) and were at lower risk of medical complications (adjusted OR, 0.61; 95% CI, 0.49-0.77) and deep vein thrombosis (adjusted odds ratio, 0.61; 95% CI, 0.47-0.80). Outpatient designation was not a significant predictor for repeat operation (p =.09). Conclusions: Outpatient laparoscopic hysterectomy procedures are not associated with increased risk of 30-day postoperative complications.