Evaluating the association of same-day discharge following minimally invasive surgery for prolapse on 30-day postoperative adverse events.

Introduction And Hypothesis: The objective was to evaluate the association of same-day discharge and outcomes following minimally invasive surgery for pelvic organ prolapse (POP).

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we identified women undergoing POP surgery between 2014 and 2018 who were discharged on the day of surgery (same-day) or on postoperative day 1 (POD1). Patient and procedural characteristics, and 30-day outcomes including readmission, reoperation, and postoperative complications, were abstracted. Multivariate logistic regression was used to determine the association of day of discharge and complications, readmission, and reoperation while controlling for potential confounders.

Results: A total of 33,614 patients met the inclusion criteria: 20% patients were discharged on the same day, whereas 80% were discharged POD1. The mean ± SD age for the cohort was 61 ± 12 years, with a median (IQR) body mass index (BMI) of 28 (25-32) kg/m. The overall postoperative complication rate was 5.4%. Patients discharged on the same day had lower rates of complications (4.8% vs 5.5%, p = 0.02) and lower rates of readmission (1.6% vs 2.0%, p = 0.03) compared with those discharged on POD1. No difference in reoperation rates (0.9% vs 1.1%, p = 0.31) were noted between groups. In multivariate logistic regression models controlling for age, race, BMI, ASA class, smoking, procedure type, and operative time, day of discharge was not associated with increased odds of postoperative complications (same-day discharge: aOR 1.00, 95% CI 0.88-1.14), reoperation (aOR 0.83, 95%CI 0.61-1.12), or readmission (aOR 0.93, 95%CI 0.74-1.16).

Conclusions: Same-day discharge did not impact the rate of adverse events after minimally invasive prolapse surgery.