Comprehensive perioperative care program to improve same-day discharge after minimally invasive gynecologic oncology surgery (MIGOS)

Kim, Rachel Soyoun Laframboise Stephane Nelson Gregg McCluskey Stuart Kujbid Nastasia Zia Aysha Oheneba-Adom Rosemary Bernardini Marcus Ferguson Sarah May Taymaa Hogen Liat Cybulska Paulina Bouchard-Fortier Genevieve

Same-day discharge (SDD) after minimally invasive hysterectomy for benign or malignant gynecologic conditions has been shown to be safe and feasible, but remains challenging to implement. We designed and implemented a quality improvement perioperative program for minimally invasive gynecologic oncology surgery (MIGOS). Our aim was to improve SDD rate from 30% to 75% over the study period, while maintaining acceptable 30-day perioperative outcomes and patient experience. Consecutive patients undergoing minimally invasive hysterectomy at a single cancer centre were included during the 9-month project period and a historical cohort of 100 consecutive patients was identified for comparison. A team of gynecologic oncologists, anesthesiologists, and nurses developed a comprehensive perioperative care program and met bi-weekly to revise interventions through plan-do-study-act (PDSA) cycles. Patients were followed for 30 days after discharge. We conducted a descriptive analysis of the characteristics of pre-MIGOS and MIGOS patient cohorts using Wilcoxon rank-sum or Fisher exact tests. We used a run chart to monitor effects of interventions on outcomes and a pre-post analysis to evaluate for statistical significance of change in SDD and perioperative outcomes. We assessed 100 consecutive pre-MIGOS and 79 consecutive MIGOS patients. Overall SDD rates increased from 31% (31/100) to 71% (56/79) after implementation (p<0.001) (Figure 1). There was a consistent increase in SDD rate after implementation, although more pronounced following the start of the COVID pandemic. The MIGOS cohort was significantly younger (59 vs. 65;p=0.04) and had shorter operative times (168 vs. 202 minutes;p<0.001) but the two groups were not different with respect to BMI, comorbidity, stage distribution, type of procedure performed, and intraoperative blood loss. We found no difference in 30-day perioperative complication rates, readmission, reoperation, clinic visits, emergency department visits, mortality or morbidity. The most common reason for overnight admission was nausea and vomiting (35%), complications related to pre-existing comorbidities (15%) and urinary retention (10%). Overall, 89% of MIGOS patients rated their experience as 'very good' or 'excellent', and 87% felt that their post-operative length of stay was adequate. [Display omitted] Following implementation of a perioperative quality improvement program targeted towards minimally invasive gynecologic oncology surgery, a multidisciplinary team significantly improved SDD rates while maintaining low 30-day perioperative complications and excellent patient experience. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)