A cost-minimisation analysis of inpatient versus day surgery for gynaecological laparoscopy

Table 1 Characteristics and operative data for patients randomised to either inpatient or day surgery

	Inpatient (n = 26)	Day surgery (n = 40)	p value
Patient characteristics
Age (mean, SD)	35.0 (9.9)	33.9 (6.9)	NS
BMI (mean, SD)	22.8 (2.5)	23.1 (3.3)	NS
Referred from GP	57.8%	55.0%	NS
Diagnostic/evaluative operation^a	46.2%	70.0%	NS
Surgeon
Consultant/registrar	84.6% (n = 22)	35.0% (n = 14)	p < 0.001 (2 × 2 table)
House surgeon	15.4% (n = 4)	65.0% (n = 26)	p < 0.001 (2 × 2 table)
Supervisor/assistant present	57.7% (n = 15)	75.0% (n = 30)	NS
Median time in minutes (IQR)
Anaesthesia	80.0 min (28.0)	62.5 min (29.2)	p < 0.001
Operation	42.5 min (34.0)	32.5 min (19.8)	NS
Recovery	110.0 min (61.2)	250.0 min (70.0)	p < 0.001
Operation
Standard anaesthesia	80.8% (n = 21)	85.0% (n = 34)	NS
Instrument error^b	3.8% (n = 1)	22.5% (n = 9)	p < 0.05
Complications^c	11.5% (n = 3)	5.0% (n = 2)	NS
Medication while in recovery
Pain killers	73.1% (n = 19)	77.5% (n = 31)	NS
Antiemetics	19.2% (n = 5)	10.0% (n = 4)	NS
Length of stay (SD)	2.3 days (1.0)	0.0 days (0.1)	p < 0.001

SD standard deviation, NS not significant, BMI body mass index, GP general practitioner. IQR interquartile range
^aIn both groups, the most frequent operative code was for diagnostic laparoscopy/biopsy (37% and 48% in inpatient and day surgery, respectively), followed by investigation/treatment of infertility (19% and 25%), cyst removal (14% and 11%), treatment of endometriosis (12% and 2%) and sterilisation procedures (5% and 3%). Each patient could have up to five operation codes; hence, there were more operative procedures (43 and 64, respectively) than patients in each group.
^bInstrument error: defective light cable, scope or camera (five day patients), defective cauteriser (one inpatient and one day patient), defective Verres cannula (two day patients)
^cComplications: one day patient admitted overnight for observation of syncope; one day patient discharged later same day after 6 hours’ observation for bradycardia; one inpatient with intraoperative perforation of uterus was discharged as planned the day after operation; laparoscopy in two inpatients was altered to laparotomy due to a tumour and large ovarian cyst, respectively.