Design: Retrospective cohort study

Setting: Academic community hospital and freestanding ambulatory surgery center

Patients or Participants: Biological females age >18 who underwent outpatient robotic hysterectomies for benign indications at CFH (Carle Foundation Hospital) (n = 316) and CSC (Carle Surgery Center) (n=152) between November 2021 and June 2023.

Interventions: Robotic assisted total laparoscopic hysterectomy

Measurements and Main Results: Preoperative health profiles between locations showed significant differences in ASA classifications, average BMI, hemoglobin levels, and uterine size (P=.05). However, no significant correlations were found between these conditions and complication rates. There were comparable rates of hypertension, diabetes, and smoking status (P>.05) between locations. Incidence and severity of complications between locations showed 22% (n=316) of CFH patients experienced complications versus 15% (n=152) at CSC without statistical significance (P=.13). Specific complication incidences varied; caution advised in interpretation due to non-significance. Complication grades by Clavien-Dindo classification system across CFH and CSC showed no significant difference (P=.60) and a uniform distribution, indicating similar patterns in complication severity. There was no significant difference between CFH (148.70 min) and CSC (139.95 min) procedure length (P=.11), indicating comparable operative times. There was however, significant difference in PACU times; CFH's average (205.29 min) is notably longer than CSC’s (116.76 min) (P<.001). Cases with observation or admission complications were excluded from this analysis to avoid distortion by outliers.

Conclusion: With comparable postoperative complication rates at CFH and CSC, the study confirms that select patients can safely undergo outpatient robotic-assisted hysterectomies at freestanding ambulatory surgery centers, supporting the model for patient care delivery. This retrospective chart review emphasizes the strategic role of ambulatory surgery centers in a resource optimized healthcare system, highlighting an innovative approach to expanding access to high quality care.