Same-day discharge (SDD) following laparoscopic treatment of ectopic pregnancy has gained increasing interest due to its potential to enhance patient satisfaction, reduce healthcare costs, and optimize hospital resources. However, limited data exist on predictors of non-SDD in this population.

To identify patient- and procedure-related factors associated with overnight admission following laparoscopic management of ectopic pregnancy.

We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We included patients who underwent laparoscopic salpingectomy with complete data on discharge status. SDD was defined as discharge on the day of surgery. Multivariable logistic regression was used to identify independent predictors of overnight stay, adjusting for age, race, BMI, ASA class, hypertension, diabetes, and anemia. Missing data were handled using multiple imputation.

Among 10,162 patients, 6245 (61 %) were discharged the same day. Blood transfusion (aOR 6.37, 95 % CI 4.98–8.15) and operative time ≥180 min (aOR 4.04, 95 % CI 1.63–10.03) were strongly associated with increased odds of overnight admission. Hispanic ethnicity (aOR 1.27, 95 % CI 1.12–1.45) and elevated creatinine (aOR 1.74, 95 % CI 0.93–3.24) were also associated, though the latter did not reach statistical significance. Higher BMI and lower hematocrit were more frequent among non-SDD patients.

Most patients undergoing laparoscopic treatment for ectopic pregnancy can be safely discharged the same day. Blood transfusion, prolonged operative time, and select preoperative characteristics increase the likelihood of overnight admission. These findings may inform perioperative planning and enhance patient selection for safe SDD protocols.