2487 Same-Day Discharge after Hysterectomy: Identifying Reasons for Unplanned Admissions and Evaluating Institutional Compliance with a Standardized Protocol

Abstract

Study Objective Same-day discharge (SDD) has been the goal of most of minimally invasive hysterectomies. Our institution adopted a standardized operating procedure (SOP) for planned SDD in 2013. The aims of this study were to identify the reasons for unplanned admissions after minimally invasive hysterectomies at our institution and critically review the SDD SOP. Design Quality assurance, retrospective cohort study Setting Single academic institution Patients or Participants We reviewed charts of 74 patients between January to June 2017 and from June to December 2018 who underwent minimally invasive hysterectomy for benign gynecologic indications. Urogynecology patients were excluded. Interventions No interventions, descriptive study. Measurements and Main Results The peri-operative hospital course our sample was compared to our institution's SOP for same-day discharge. The average age of our cohort was 44 with an average body mass index of 27. Mean post-operative acute care unit stay was 4.7 hours (range 2.5 - 11.1 hours); 34% of patients stayed less than the 4 hours required in the SDD SOP, but none of these patients had post-operative emergency room visits or hospital re-admissions. Documentation of SDD SOP-recommended pre-operative counseling (43%) and intra-operative bladder backfilling (8%) was poor. Unplanned admissions on the day of surgery occurred in 17 (22.9%): 9 (52.9%) were for medical (23.5%) or surgical (29) complications, while 2 (12%) had voiding dysfunction and 2 (12%) had pain. Age, hysterectomy route, length of surgery, and estimated blood loss were not associated with these unplanned admissions. Conclusion Our quality assurance project identified that our unplanned admissions for nausea and pain could potentially be avoided with implementation of enhanced recovery after surgery protocol, including pre-operative counseling of expectations and same-day discharge information. Voiding dysfunction requiring admission could be decreased by performing active voiding trials in recovery area. Consider creating a protocol for goals at recovery room before discharge instead of a time frame to discharge.