Same day discharge (SDD) after surgery for gynecologic cancer patients in Germany ?

Aim Ambulatory surgery is well established outside Europe for women diagnosed with gynecologic cancer. Overstrained hospital staff, multi-resistant nosocomial hospital germs and pending pandemics are arguments for same day discharge (SDD). What is the reason that this option is not offered to patients in Germany? Does lack of surgical skills of gynecologic oncologists explain this phenomenon? Patients and Methods Between April 2024 and December 2025 83 consecutive cancer patients underwent outpatient surgery at Eviamed Oncology Center. The majority of patients were diagnosed with cervical cancer (n=41), followed by cancer of vulva (n=27), corpus uteri (n=8), vagina (n=5) or ovary (n=1). Major surgery was performed laparoscopically in 35 patients by lymphadenectomy (LNE) alone or vaginal-assisted simple (LAVH) or radical hysterectomy (VALRH) and in 15 patients by inguinal LNE combined with vulvectomy. Pre- and postoperative findings were presented and discussed in an interdisciplinary tumor board. Postoperatively all patients were contacted by phone for their well-being and received a check-up examination by the responsible surgeon. We made sure that the patients had family support up to postoperative day 5. Results In the laparoscopy group mean age of was 49 (24 - 87)years, mean BMI 27.3 (18.8-43.8), interval between incision and suture 147 (70-288) min, duration of narcosis 183 (90-338) minand of postoperative observation 151 (83-260) min. Vulva patients were on average 18 years older with similar BMI and up to 40% shorter time intervals. There were no intraoperative complications, no conversion to laparotomy and no hospital admission within 30 days post surgery. One ureter leakage, 3 symptomatic lymphoceles and one urinary tract infection had to be treated in the laparoscopy group and 1 symptomatic lymphocele in the vulva group. A cost-utility analysis using the actual German reimbursement system showed a considerable deficit for the surgical part of LAVH & LNE. Conclusion The reason that SDD is not offered to patients in Germany is not incompetence of the gynecologic oncologists but inadequate reimbursement by the health insurance providers.