15 Outcomes following same-day discharges following minimally invasive prolapse surgery

Abstract

To describe outcomes and assess factors associated with complications following same-day discharge for minimally invasive surgery (MIS) for prolapse (POP). Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we identified women undergoing POP surgery between 2012 and 2018 who were discharged on postoperative day 0 (POD0) or 1(POD1) using postoperative diagnosis code. Procedure codes were used to select patients who underwent MIS. Patient and procedural characteristics as well as readmission, reoperation, and 30-day postoperative complications (POCs) were abstracted. Descriptive statistics were used to describe the cohort, and bivariate analyses were performed to describe differences between patients discharged on POD0 and POD1. Multivariable logistic regression (MVLR) was used to determine the role of day of discharge on POC, readmission and reoperation controlling for potential confounders. There were 23,540 patients who met inclusion criteria: 19% patients were discharged POD0, while 81% 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/m2. The majority was white (90%) with an ASA class 2 (68%), and nearly half had a major medical comorbidity (43%). Overall complication rate was 5.5%; UTI was most common (3.9%) followed by superficial surgical site infection (SSI) (0.5%) and organ/space SSI (0.4%). Table 1 shows differences in characteristics between the two cohorts. Of note, patients discharged on POD0 had lower rates of POC compared to those discharged on POD1 (4.8% vs 5.6%, P = 0.04); however, no differences in readmission (1.6% vs 1.9%, P = 0.1) or reoperation rates (1.1% vs 1.1%, P = 0.74) were found in patients discharged POD0 or POD1. In MVLR models controlling for age, race, BMI, ASA class, procedure type, and operative time, day of discharge was not independently associated with increased odds of POC (aOR = 0.99, 95% CI = 0.85-1.16) nor was increased odds of reoperation (aOR = 1.1, 95% CI = 0.80-1.54); however, POD1 discharge was associated with decreased odds of readmission (aOR = 0.71, 95% CI = 0.66-0.77). Interaction analysis showed no differences in risk factors in risk factors for POC, reoperation and readmission between the POD0 and POD1 groups. After controlling for confounders, same-day discharge was not associated with increased odds of postoperative complications or reoperation in women undergoing MIS for POP; however, it was associated with increased odds of readmission.