Date of Award

2026-04-16

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Caroline Etland, PhD, RN, CNS, ACHPN, Committee Member; Razel B. Milo, PhD, DNP, MSN, FNP-C, Committee Member

Keywords

ambulatory, robotic, same-day discharge, gynecological surgery

Abstract

Background: The use of minimally invasive surgical techniques and robotics allows gynecologic procedures, once requiring large open incisions, to be completed as an ambulatory procedure. Ambulatory procedures allow patients to recover in their own home. Patients bring different variables to the perioperative setting, such as age, body mass index (BMI), comorbidities, and health history. Surgeons and anesthesiologists bring different practices to the surgical setting. Each patient’s recovery is unique, and not all meet discharge criteria to go home the day of their surgery.

Purpose: This study examines relationships between patient preoperative comorbidities, intraoperative anesthetic agents, duration of surgery, patient sedation, postoperative nausea and vomiting, prolonged postanesthesia care unit (PACU) length of stay, discharge readiness, and same-day discharge rates among robotic gynecologic ambulatory surgical patients in a Southern California free-standing women’s hospital.

Conceptual Basis: The Roy Adaptive Model addresses individuals ability to adapt to environmental stimuli. Patients’ ability to effectively cope with the stimulus of surgery represents successful adaptation and results in discharge home.

Methods: This study used a retrospective, descriptive, correlational design. Data were extracted from the electronic health record of women aged 18 to 80, who underwent robotic gynecologic surgery between January 2021 and December 2024.

Results: Sixty-seven percent of the sample (n = 500) were discharged home the day of their surgery. Same-day discharge patients were younger (p < .001), had a lower BMI (p = .049), shorter duration of surgery (p < .001), and longer PACU stay (p < .001) than those discharged home on a different day. Surgeons performing a greater number of surgeries during the four years were associated with increased same-day discharge rates (85.6%) compared to surgeons performing the least number of surgeries (59.6%). The logistic regression model was significant (p < .001), with the strongest predictor of same-day discharge the total number of surgeries performed by the surgeon (OR = 1.01).

Conclusion and Implications: The study identified six significant variables predicting same-day discharge, which may help inform practice changes, preoperative planning and patient education.

Document Type

Dissertation: Open Access

Department

Nursing

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Available for download on Thursday, May 04, 2028

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