Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients

Nigel Madden, Melissa K. Frey, Li Jin Joo, Jessica Lee, Kelsey Musselman, Jing Yi Chern, Stephanie V. Blank, Bhavana Pothuri

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. Objective: The objective of the study was to evaluate discharge timing and surgical outcomes in elderly compared with younger patients undergoing robotic-assisted gynecologic surgery. Study Design: This was a retrospective cohort study of all patients who underwent robotic-assisted gynecologic surgery at a high-volume, single institution from January 2013 through May 2016. Demographic information, discharge timing, and peri- and postoperative outcomes were compared for patients <65 years with those ≥65 years using univariate and multivariate analyses. Results: There were 2757 patients included, with 2521 <65 years and 236 ≥65 years. Median age of the younger group was 42 years, while the median age of the elderly group was 69 years. Elderly patients had a higher body mass index (kilograms per square meter) (28 vs 26, P < .001) and higher American Society of Anesthesia classification (P < .001). Elderly were more likely to have malignancy as the indication for surgery (68% vs 11%, P < .001) and to undergo hysterectomy (81% vs 38%, P < .001) or surgery with lymph node dissection (44.5% vs 7.1%, P < .001). Elderly patients had a higher incidence of intraoperative complications (9% vs 4.6%, P = .002) and longer median hospital stay (17 vs 7 hours, P < .001) compared with younger patients. Same-day discharge was more common in younger patients (76% vs 45%, P < .001), and elderly patients were more likely to have admissions lasting >23 hours (13% vs 3%, P < .001) on univariate and multivariate analysis. Analysis of postoperative outcomes included 2023 patients with available postoperative data (80% of total population) (1794 <65 years, 229 ≥ 65 years). There were no differences between elderly and younger patients in overall postoperative complications, reoperations, intensive care unit admissions, emergency room visits, or hospital readmission within 6 weeks of surgery. Conclusion: Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.

Original languageEnglish (US)
Pages (from-to)253.e1-253.e7
JournalAmerican journal of obstetrics and gynecology
Volume220
Issue number3
DOIs
StatePublished - Mar 2019
Externally publishedYes

Fingerprint

Gynecologic Surgical Procedures
Robotics
Safety
Patient Readmission
Ambulatory Surgical Procedures
Reoperation
Population
Intensive Care Units
Hospital Emergency Service
Length of Stay
Cohort Studies
Multivariate Analysis
Retrospective Studies
Demography
Morbidity

Keywords

  • early hospital discharge
  • elderly
  • robotic-assisted surgery

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients. / Madden, Nigel; Frey, Melissa K.; Joo, Li Jin; Lee, Jessica; Musselman, Kelsey; Chern, Jing Yi; Blank, Stephanie V.; Pothuri, Bhavana.

In: American journal of obstetrics and gynecology, Vol. 220, No. 3, 03.2019, p. 253.e1-253.e7.

Research output: Contribution to journalArticle

Madden, Nigel ; Frey, Melissa K. ; Joo, Li Jin ; Lee, Jessica ; Musselman, Kelsey ; Chern, Jing Yi ; Blank, Stephanie V. ; Pothuri, Bhavana. / Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients. In: American journal of obstetrics and gynecology. 2019 ; Vol. 220, No. 3. pp. 253.e1-253.e7.
@article{8a1e211f986a48709ffe7b265e679c72,
title = "Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients",
abstract = "Background: A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. Objective: The objective of the study was to evaluate discharge timing and surgical outcomes in elderly compared with younger patients undergoing robotic-assisted gynecologic surgery. Study Design: This was a retrospective cohort study of all patients who underwent robotic-assisted gynecologic surgery at a high-volume, single institution from January 2013 through May 2016. Demographic information, discharge timing, and peri- and postoperative outcomes were compared for patients <65 years with those ≥65 years using univariate and multivariate analyses. Results: There were 2757 patients included, with 2521 <65 years and 236 ≥65 years. Median age of the younger group was 42 years, while the median age of the elderly group was 69 years. Elderly patients had a higher body mass index (kilograms per square meter) (28 vs 26, P < .001) and higher American Society of Anesthesia classification (P < .001). Elderly were more likely to have malignancy as the indication for surgery (68{\%} vs 11{\%}, P < .001) and to undergo hysterectomy (81{\%} vs 38{\%}, P < .001) or surgery with lymph node dissection (44.5{\%} vs 7.1{\%}, P < .001). Elderly patients had a higher incidence of intraoperative complications (9{\%} vs 4.6{\%}, P = .002) and longer median hospital stay (17 vs 7 hours, P < .001) compared with younger patients. Same-day discharge was more common in younger patients (76{\%} vs 45{\%}, P < .001), and elderly patients were more likely to have admissions lasting >23 hours (13{\%} vs 3{\%}, P < .001) on univariate and multivariate analysis. Analysis of postoperative outcomes included 2023 patients with available postoperative data (80{\%} of total population) (1794 <65 years, 229 ≥ 65 years). There were no differences between elderly and younger patients in overall postoperative complications, reoperations, intensive care unit admissions, emergency room visits, or hospital readmission within 6 weeks of surgery. Conclusion: Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.",
keywords = "early hospital discharge, elderly, robotic-assisted surgery",
author = "Nigel Madden and Frey, {Melissa K.} and Joo, {Li Jin} and Jessica Lee and Kelsey Musselman and Chern, {Jing Yi} and Blank, {Stephanie V.} and Bhavana Pothuri",
year = "2019",
month = "3",
doi = "10.1016/j.ajog.2018.12.014",
language = "English (US)",
volume = "220",
pages = "253.e1--253.e7",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients

AU - Madden, Nigel

AU - Frey, Melissa K.

AU - Joo, Li Jin

AU - Lee, Jessica

AU - Musselman, Kelsey

AU - Chern, Jing Yi

AU - Blank, Stephanie V.

AU - Pothuri, Bhavana

PY - 2019/3

Y1 - 2019/3

N2 - Background: A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. Objective: The objective of the study was to evaluate discharge timing and surgical outcomes in elderly compared with younger patients undergoing robotic-assisted gynecologic surgery. Study Design: This was a retrospective cohort study of all patients who underwent robotic-assisted gynecologic surgery at a high-volume, single institution from January 2013 through May 2016. Demographic information, discharge timing, and peri- and postoperative outcomes were compared for patients <65 years with those ≥65 years using univariate and multivariate analyses. Results: There were 2757 patients included, with 2521 <65 years and 236 ≥65 years. Median age of the younger group was 42 years, while the median age of the elderly group was 69 years. Elderly patients had a higher body mass index (kilograms per square meter) (28 vs 26, P < .001) and higher American Society of Anesthesia classification (P < .001). Elderly were more likely to have malignancy as the indication for surgery (68% vs 11%, P < .001) and to undergo hysterectomy (81% vs 38%, P < .001) or surgery with lymph node dissection (44.5% vs 7.1%, P < .001). Elderly patients had a higher incidence of intraoperative complications (9% vs 4.6%, P = .002) and longer median hospital stay (17 vs 7 hours, P < .001) compared with younger patients. Same-day discharge was more common in younger patients (76% vs 45%, P < .001), and elderly patients were more likely to have admissions lasting >23 hours (13% vs 3%, P < .001) on univariate and multivariate analysis. Analysis of postoperative outcomes included 2023 patients with available postoperative data (80% of total population) (1794 <65 years, 229 ≥ 65 years). There were no differences between elderly and younger patients in overall postoperative complications, reoperations, intensive care unit admissions, emergency room visits, or hospital readmission within 6 weeks of surgery. Conclusion: Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.

AB - Background: A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. Objective: The objective of the study was to evaluate discharge timing and surgical outcomes in elderly compared with younger patients undergoing robotic-assisted gynecologic surgery. Study Design: This was a retrospective cohort study of all patients who underwent robotic-assisted gynecologic surgery at a high-volume, single institution from January 2013 through May 2016. Demographic information, discharge timing, and peri- and postoperative outcomes were compared for patients <65 years with those ≥65 years using univariate and multivariate analyses. Results: There were 2757 patients included, with 2521 <65 years and 236 ≥65 years. Median age of the younger group was 42 years, while the median age of the elderly group was 69 years. Elderly patients had a higher body mass index (kilograms per square meter) (28 vs 26, P < .001) and higher American Society of Anesthesia classification (P < .001). Elderly were more likely to have malignancy as the indication for surgery (68% vs 11%, P < .001) and to undergo hysterectomy (81% vs 38%, P < .001) or surgery with lymph node dissection (44.5% vs 7.1%, P < .001). Elderly patients had a higher incidence of intraoperative complications (9% vs 4.6%, P = .002) and longer median hospital stay (17 vs 7 hours, P < .001) compared with younger patients. Same-day discharge was more common in younger patients (76% vs 45%, P < .001), and elderly patients were more likely to have admissions lasting >23 hours (13% vs 3%, P < .001) on univariate and multivariate analysis. Analysis of postoperative outcomes included 2023 patients with available postoperative data (80% of total population) (1794 <65 years, 229 ≥ 65 years). There were no differences between elderly and younger patients in overall postoperative complications, reoperations, intensive care unit admissions, emergency room visits, or hospital readmission within 6 weeks of surgery. Conclusion: Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.

KW - early hospital discharge

KW - elderly

KW - robotic-assisted surgery

UR - http://www.scopus.com/inward/record.url?scp=85060737172&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060737172&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2018.12.014

DO - 10.1016/j.ajog.2018.12.014

M3 - Article

C2 - 30557552

AN - SCOPUS:85060737172

VL - 220

SP - 253.e1-253.e7

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 3

ER -