Comparison of 30-Day Readmission After Same-Day Compared With Next-Day Discharge in Minimally Invasive Pelvic Organ Prolapse Surgery

Abstract

OBJECTIVE: To compare the effect of same-day discharge on 30-day readmission risk after minimally invasive pelvic reconstructive surgery. METHODS: This retrospective cohort study included all minimally invasive pelvic reconstructive procedures with and without concomitant hysterectomy performed within a large managed care organization of 4.5 million members from 2008 to 2018. We queried the system-wide medical record for Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revision codes for all included procedures and patient perioperative data. Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department (ED) visits. Perioperative data and 30-day outcomes were compared using χ2 for categorical variables and Kruskal-Wallis for continuous variables. We performed a multivariate logistic regression adjusting for perioperative variables and their potential effect. RESULTS: Of the 13,445 patients undergoing pelvic reconstructive surgery, 5,506 were discharged the same day and 7,939 were discharged the next day. There was no difference in 30-day readmission comparing those discharged the same day with those discharged the next day (odds ratio [OR] 0.79; 95% CI 0.60–1.03; 1.5% vs 2.0%, P=.07). Concomitant hysterectomy was performed in 6,171 individuals: There was no difference (OR 0.90; 95% CI 0.60–1.33; 1.9% vs 2.1%, P=.59) in 30-day readmission rates when comparing those discharged on the same day with those discharged the next day. We also found no difference in 30-day readmissions rates when comparing same-day with next-day discharge (OR 1.33, 95% CI 0.79–2.26; 2.8% vs 2.1%, P=.28) in (n=3,482) individuals undergoing vaginal hysterectomy. For those who did not undergo hysterectomy at the time of their prolapse surgery, there was no difference (OR 0.77; 95% CI 0.53–1.13; 1.3% vs 1.7%, P=.18) in 30-day readmission when comparing those discharged the same day with those discharged the next day. After adjustment for patient and perioperative characteristics, there was no statistically significant difference in the readmission risk for individuals with same-day discharge compared with next-day discharge among those with (adjusted odds ratio [aOR] 0.91; 95% CI 0.61–1.36; P=.63) and without (aOR 0.86; 95% CI 0.58–1.27; P=.45) a concomitant hysterectomy. For the secondary outcome of 30-day ED visits, we found no statistically significant differences when comparing same-day with next-day discharge for the entire cohort, those with concomitant hysterectomy, or when controlling for patient and perioperative characteristics. CONCLUSION: In women undergoing minimally invasive pelvic reconstructive surgery within a large managed care organization, there is no difference in 30-day readmission or ED visit rates between those discharged the same day and those discharged the next day. When considering patient factors, same-day discharge after minimally invasive pelvic reconstructive surgery may be safe and play an important role in value-based care.

Same‐day discharge across FPMRS surgical cases is safe and feasible: A 10‐year single‐surgeon experience

“…Several recent studies have evaluated SDD for minimally invasive major pelvic organ prolapse repairs and have also shown low readmission rates. A recent population‐based study by Berger and colleagues of over 13 000 patients in a managed care organization comparing same‐day and next‐day discharge following minimally invasive major prolapse surgery reported low 30‐day readmission (1.5%–2%) and ED visit (9.5%) rates with no differences between discharge groups 7 . A prospective cohort study of SDD after minimally invasive sacrocolpopexy from our institution demonstrated no difference in unscheduled office visits, ED visits or readmissions with SDD compared to historical controls admitted postoperatively 8 .…”

“…Several groups have since reported SDD outcomes following minimally invasive pelvic organ prolapse repair, demonstrating high success rates and patient satisfaction without increase in postoperative complications or unplanned healthcare use. [4][5][6][7] Between this growing body of evidence supporting SDD for major prolapse repair and our clinical experience, we hypothesized that SDD can be safely used across the majority of a FPMRS practice.…”

Surgical Outcomes in Benign Gynecologic Surgery Patients during the COVID-19 Pandemic (SOCOVID study)

“…Prior to the pandemic, same-day discharge was shown to be feasible 10 with no differences seen in readmission after hysterectomy 11 or pelvic organ prolapse surgery. 12 In light of the current pandemic, our study suggests the additional benefit of limiting the duration of post-operative hospital stay to also include reduced odds of acquiring nosocomial COVID infection.…”

Sacrocolpopexy using autologous rectus fascia: cohort study of long-term outcomes and complications

“…21,22 The ongoing COVID-19 pandemic has further pushed this goal to decrease hospital exposures and led to same-day discharge after pelvic reconstructive surgery with good outcomes. 23 The advent of ERAS programs have aided in this goal. We did see a decrease in length of stay in patients that underwent surgery after standardized ERAS protocols were initiated at our hospital.…”