Outcomes of an Overnight-Stay Unit for Urogynecologic Surgery: Feasibility and Risk Factors for Failure of Next-Day Discharge

Abstract

Objective To evaluate outcomes of patients undergoing urogynecologic procedures with postoperative care in an overnight-stay unit at a tertiary care center. Methods A retrospective cohort study of 1644 women admitted to an overnight-stay unit at a Canadian tertiary care center after urogynecologic surgery between 2014 and 2018 was completed. A multivariable logistic regression model was fit to identify risk factors for failed next-day discharge, defined as a delayed discharge of more than 24 hours, readmission within 30 days of surgery, or emergency room assessment within 7 days of surgery. Results One thousand five hundred seventy-eight patients (96%) were discharged within 24 hours of surgery. Mean patient age was 53.7 ± 15.1 years, with 21.2% 70 years or older. Surgical approaches included laparotomies (8.9%), major vaginal surgery (70.9%), and open retropubic procedures (2.1%). Hysterectomies were performed in 1120 patients (68.1%). One hundred one patients (6.1%) were assessed in the emergency department within 7 days of surgery, and 57 (3.5%) were readmitted to hospital within 30 days of their procedure. Multivariable regression identified the following as risk factors for failed next-day discharge: pulmonary disease (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.32–8.06; P = 0.010), longer operating time (OR, 1.40; 95% CI, 1.10–1.79; P = 0.006, per 60 minutes), and intraoperative hemorrhagic complications (OR, 22.64; 95% CI, 5.83–88.00, P < 0.001). Conclusions Admission to an overnight-stay unit with next-day discharge is feasible for most patients undergoing urogynecologic surgery. Factors associated with requiring a longer hospital stay, presentation to an emergency department, or readmission to hospital within 7 days include pulmonary disease, longer operating times, and intraoperative hemorrhagic complications.

Cognitive impairment does not impact sacral neuromodulation implant rates for overactive bladder

“…Although age 60 years or more is considered by the World Health Organization as "older," 15 we used age 55 years as the lower limit for inclusion criteria to capture patients who may have earlier onset cognitive impairment and/or received a diagnosis during their follow-up period after implantation. 16 Multiple community prevalence studies of cognitive impairment include patients starting at age 55, [17][18][19] and prior study has suggested age-related cognitive decline begins and advances after age 55. 20 Patient demographics, comorbidities, CI diagnoses, use of OAB medication and/or onabotulinum toxin, and SNM procedure details were collected.…”