Analysis of ambulatory gynecological laparoscopy in Southwestern China and predictors of discharge: a retrospective cohort : Ambulatory surgery delayed discharge analysis.

OBJECTIVE

To present a regional cohort analysis of ambulatory gynecological laparoscopy in Southwestern China and establish predictors of delayed discharge.

METHODS

This retrospective cohort study analyzed patients undergoing planned ambulatory gynecological laparoscopy at West China Second University Hospital, Sichuan University (January 2021-January 2024), excluding unplanned/converted procedures. Multivariable logistic regression was used to identify predictors of delayed discharge (> 24-h hospitalization), incorporating demographic/clinical variables: operative duration, procedure completion time, postoperative nausea and vomiting (PONV), and visual analog scale (VAS) pain scores. Model discrimination was evaluated using the area under the receiver-operating characteristic curve (AUC). The primary outcome was scheduled discharge (within 24 h of admission).

RESULTS

Among 2007 patients, 1938 (96.6%) achieved scheduled discharge. Independent predictors of delay included: Advancing age (OR 0.93, 95% CI 0.90-0.96), Prolonged operative duration (> 90 min; OR 0.17, 95% CI 0.05-0.54; strongest predictor with AUC = 0.82), Late-evening procedure completion (after 22:00; OR 0.13, 95% CI 0.02-0.76), PONV (OR 0.20, 95% CI 0.10-0.42), Elevated postoperative pain (VAS OR 0.53, 95% CI 0.42-0.67). The composite model demonstrated excellent discrimination (AUC 0.91, 95% CI 0.877-0.932). Safety outcomes were reassuring: 30-day unplanned visit rate 0.57% (p > 0.05 vs timely discharge group), with no readmissions.

CONCLUSIONS

Optimizing operative duration (particularly avoiding > 90-min procedures) and minimizing late-evening scheduling may improve discharge efficiency. Proactive management of PONV and early postoperative pain could further reduce delays. The low postdischarge healthcare utilization supports the safety of ambulatory pathways.