8465 Same-Day Discharge (SDD) after Total Laparoscopic Hysterectomy (TLH) in a High-Risk Patient Population

Abstract

<h3>Study Objective</h3> To examine whether SDD (discharge prior to midnight on day of surgery) is safe and feasible in a high-risk patient population. Secondary outcome was post-operative complications within twelve weeks of surgery. <h3>Design</h3> Retrospective chart review. <h3>Setting</h3> High-volume, safety-net hospital caring for predominantly Hispanic-White, African American, non-English speaking, and/or uninsured or under insured patients with 5^th grade average reading level. <h3>Patients or Participants</h3> Patients receiving TLH June 2014 - January 2019. This captures the transition in practice to universal SDD in 2017. <h3>Interventions</h3> TLH performed by two high volume Minimally Invasive Gynecologic Surgeons. <h3>Measurements and Main Results</h3> 309 patients, 95 (31%) had SDD while 214 (69%) were admitted. After the transition in 2017, the SDD rate increased from 0% (2014) to 73% (2018). No statistically significant differences were noted in baseline characteristics between groups including: Age, race, ethnicity, hemoglobin, or surgery indication. The majority of patients self-reported a language other than English as their primary language (58% SDD vs. 53% admission). There were no differences between group's pre-operative comorbidities including BMI (33kg/m²), presence of hypertension, diabetes, or opioid use. There was no statistically significant difference between groups based on ASA classification, with most being class 2 (58% vs. 60%) or 3 (40% vs. 38%). There were no differences between SDD and admission groups in mean estimated blood loss (134mLs vs. 166mls) or uterine weights (314gms vs. 327gms). Six patients (2%) were readmitted post-operatively, and there was no difference in readmission rate between groups. <h3>Conclusion</h3> SDD is safe in a high-risk patient population and does not increase post-operative readmission rate. Patients who are uninsured or underinsured, do not speak English as a primary language, have low health literacy, and/or who are ASA class 2-3 can safely be offered SDD. We demonstrate that high-risk patients should be included in SDD research and highlight the importance of equity and inclusivity in surgical outcomes research.