RESULTS OF SELECTIVE USE OF OPERATIVE LAPAROSCOPY IN GYNECOLOGIC ONCOLOGY

Objective. To evaluate the impact of integration of operative laparosc opy on length of stay (LOS) and complication rates on an academic gyne cologic oncology service. Methods, Retrospective analysis of all admis sions to our gynecologic oncology service was performed for the academ ic years 1990/1991 and 1993/1994, Primary endpoints were frequency of complications and LOS. Results. In 1990/1991, there were 785 total adm issions, of which 287 were surgical and 3% were approached laparoscopi cally, In 1993/1994, there were 973 admissions of which 436 were surgi cal and 23% were approached laparoscopically. Operative laparoscopy wa s applied equally regardless of age and reproductive status; the utili zation of laparoscopy was increased by 14-fold for patients with cance r, 4.5-fold for patients with benign disease, and 12-fold for patients with adnexal masses. No change in the mean LOS of nonsurgical admissi ons was noted, yet overall LOS for all patients decreased from 6.3 to 4.8 days (P < 0.0001), Mean LOS in surgical patients decreased from 9. 4 to 6.0 days (P < 0.0001). After correction for complications, decrea ses in LOS only occurred in procedures for which laparoscopy was signi ficantly integrated. No reductions in LOS were noted with like surgica l approaches; i.e., there was no change in the LOS of patients undergo ing laparotomy in both years. Surgical complications were not increase d by laparoscopy, Conclusions. Aggressive utilization of operative lap aroscopy, even only for selected patients, into the surgical practice of a gynecologic oncology service demonstrates significant improvement s in LOS without adversely affecting surgical complication rates. (C) 1998 Academic Press.