Early-discharge pathway01
95GUTA-CLINIC
2022–2025 · target discharge ≤26 hours
Clinical research · Laparoscopic myomectomy
Discharge Within 26 Hours After Laparoscopic Myomectomy: A Comparative Cohort Study
A retrospective two-centre, two-period comparative cohort study of 190 consecutive elective operations performed by one surgeon.
No signal of increased serious 30-day adverse outcomes was observed.
190operations
95 + 95cohorts
26 hoursdischarge pathway
LM-DRS-26domains
190 / 190exact agreement
01 · Study question
Can a structured pathway bring discharge forward without an observed increase in serious harm?
The study compared a structured 26-hour discharge pathway with a historical internal five-day-stay protocol after elective laparoscopic myomectomy. Outcomes were postoperative stay, discharge within 26 hours, serious 30-day events and study-defined readiness.
Calendar dates in the database were systematically shifted during de-identification. Chronological order and all within-patient time intervals were preserved.
DesignRetrospective comparative cohort
SettingTwo centres · two periods
OperatorSingle surgeon
Follow-up30 days · complete 190/190
02 · Patient cohorts
Consecutive laparoscopic myomectomies across two care models
Continuous data are presented as median (interquartile range).
Historical inpatient model02
95MEDSI Clinical Hospital No. 1
2018–2022 · internal five-day-stay protocol
Recorded characteristicEarly pathwayHistorical model
Age, years34 (29–43)36 (28–43)
BMI, kg/m²23.7 (21.9–27.3)24.2 (21.8–27.4)
Preoperative Hb, g/L124.0 (120.5–128.0)124.0 (120.0–127.0)
Largest fibroid, cm6 (5–7)6 (5–7)
Fibroids removed2 (1–3)2 (1–3)
Operating time, min74 (66.5–82)75 (60–85)
Estimated blood loss, mL59 (47–87)75 (56–76)
Preoperative eligibilityHb ≥100 g/LLast haemoglobin measured within 10 days of admission
Data completeness190 / 190All recorded values met the eligibility threshold
Hb <120 g/L12 / 95 vs 11 / 9512.6% in the early pathway vs 11.6% in controls
03 · Main results
Length of stay changed materially; the serious-event signal did not.
Median postoperative stay24.0hoursIQR 23.1–24.8
98.9%
Discharged within 26 hours94 of 95
One conversion remained under observation.
Early pathway24.0 h
Historical model120.6 h
Median length of stay: 24.0 vs 120.6 hours, Mann–Whitney U p<0.001.
04 · 26-hour pathway
A clinical decision point, not an automatic discharge clock
The pathway combines recovery milestones, an eight-domain score, red-flag review and clinician judgement. Historical discharge was policy-governed and not based on LM-DRS-26.
End of surgery
The postoperative interval begins at the documented end of the procedure.
Structured recovery
Oral analgesia, intake, mobilisation and voiding are actively assessed.
LM-DRS-26 at ≤26 h
Eight domains are scored 0–2 from a standardised clinical record.
Clinician decision
Discharge proceeds only when score, red flags and clinical judgement align.
05 · LM-DRS-26
Eight domains. Sixteen possible points. One clinical gate.
LM-DRS-26 is a preliminary author-developed, chart-based readiness instrument. It is not yet externally validated and does not replace clinician judgement.
Blinded inter-rater scoring assessment190 / 190exact agreement
Across all domains, total score, readiness category and red-flag status.
01Haemodynamics & respiration+
Stable observations, oxygen independence and no clinically important orthostatic symptoms.
02Bleeding & anaemia+
No ongoing bleeding or symptomatic anaemia requiring intervention.
03Pain+
Pain controlled with an oral regimen and compatible with mobilisation.
04Nausea, vomiting & intake+
Oral fluids and light food tolerated without recurrent vomiting.
05Independent activity+
Independent standing, walking and bathroom use.
06Urination+
Spontaneous, adequate voiding without clinically important retention.
07Abdomen, wounds & discharge+
Reassuring examination, dry wounds and no concerning vaginal loss.
08Recovery at home+
Instructions understood, contact pathway and practical support confirmed.
Early pathway93ready1 conditional repeat · 1 not ready
Historical model95ready at ≤26 hdischarge remained protocol-led
Median total score16in both cohortsmaximum possible score: 16
Median assessment time21.2vs 22.9 hearly pathway vs historical model
Because ratings were identical with marked ceiling concentration, κ and ICC were not reported as informative reliability estimates.
06 · 30-day safety
No observed increase in serious adverse outcomes
All 190 operations had documented 30-day follow-up. Low event counts limit precision and do not establish equivalence.
OutcomeEarlyHistorical
Serious composite safety event0 / 950 / 95
Clavien–Dindo IIIa+0 / 950 / 95
Readmission0 / 950 / 95
Reoperation0 / 950 / 95
Unplanned clinical contact1 / 950 / 95
07 · Interpretation
What the data support
A structured pathway was associated with substantially earlier discharge after laparoscopic myomectomy, with no observed signal of increased serious 30-day harm. Historical prolonged stay appeared to reflect institutional policy rather than failure to meet study-defined next-day readiness criteria.
Key limitations
- Retrospective historical-control design with complete centre-period-pathway confounding.
- Two centres, but all procedures were performed by one surgeon.
- Historical length of stay reflects a fixed institutional protocol, not clinical unreadiness until day 5.
- Rare event counts and sample size preclude equivalence or non-inferiority conclusions.
- LM-DRS-26 has preliminary internal chart-based assessment only; external validation is required.