1406 Same-Day Discharge Following Vaginal Hysterectomy with Pelvic Floor Reconstruction: A Pilot Study

Abstract

Study Objective Determine safety and feasibility of same-day discharge in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. Design Prospective cohort pilot study. Setting Single academic medical center. Patients or Participants Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. Interventions Same-day discharge or overnight hospitalization following surgery. Measurements and Main Results A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women that were planned for overnight hospitalization. The intervention group had 36 women that were planned for same-day discharge. In the intervention group, 63.9% of patients (n=23) were successfully discharged home and 36.1% (n=13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness) (n=9; 69%), uncontrolled pain (n=1, 7.7%), fever (n=1, 7.7%), anemia (n=2, 15.4%), with return to operating room for hematoma evacuation (n=1; 7.7%). Voiding trial was passed on first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (p = 0.011). There were no significant differences in the number of emergency department visits (p=0.677) or unplanned office visits (p=0.193) between the control and intervention groups. Conclusion Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same-day did not require a higher volume of emergency department or office evaluations.