Trends in Same-Day Discharge Rate After Minimally Invasive Sacrocolpopexy and Propensity Score–Matched Analysis of Postoperative Complication Rates Using the National Surgical Quality Improvement Program Database

Abstract

ObjectiveThe primary aim of this study was to review trends in the same-day discharge (SDD) rate after minimally invasive sacrocolpopexy (MISCP). The secondary aim was to compare the composite 30-day postoperative complication rates between propensity score–matched SDD and admitted cohorts.MethodsThis was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2019. Patients who underwent MISCP were identified by Current Procedural Terminology codes. Concurrent hysterectomy, anterior or posterior repairs, rectopexy, and midurethral sling were also identified. Multivariable logistic regression and propensity score matching were performed.ResultsA total of 12,762 MISCP patients were captured: 3,968 underwent MISCP only, 4,065 underwent MISCP with total laparoscopic hysterectomy, 734 underwent MISCP with laparoscopically assisted vaginal hysterectomy, and 3,995 underwent MISCP with laparoscopic supracervical hysterectomy. Overall, the SDD rate was 16.3%, with an increase from 12.3% in 2015 to 23.1% in 2019. Multivariable logistic regression showed that admitted patients were more likely to be older, to be of Black race, have an American Society of Anesthesiologists classification of 3 or 4, have hypertension requiring medication, have longer operative time, and have undergone concurrent anterior or posterior repair, rectopexy, or sling. After propensity score matching, the composite postoperative complication rates were similar between the 2 cohorts (5.7% vs 6.4%, P = 0.818). However, superficial surgical site infection was more likely in the SDD cohort (adjusted odds ratio, 2.3; P < 0.001) and blood transfusion in the admitted cohort (adjusted odds ratio, 11.9; P = 0.0.34).ConclusionsThe rate of SDD after MISCP seems to be increasing. Composite postoperative complication rates are similar between SDD and admitted cohorts.

Effects of Same-Day Discharge on 30-Day Readmission Rates in Women Aged 65 Years and Older Undergoing Minimally Invasive Pelvic Organ Prolapse Surgery

“…Approximately 200,000 women undergo surgery annually for POP, 8 often with concomitant hysterectomy, and patients have a 13% cumulative risk of having surgery for POP by age 80 years, with the annual risk increasing with age and peaking in women older than age 65 years. 9 Although there is evidence that same-day discharge is safe after POP surgery, [3][4][5][6][7]10,11 there is a lack of vital studies looking at older adults exclusively. Broader application of same-day discharge and its adoption in urogynecology and reconstructive pelvic surgery have the potential to lead to significant public health benefits, including reduced costs, higher patient satisfaction, and improved hospital resource utilization.…”