Is Same Day Discharge (SDD) after Minimally Invasive Sacrocolpopexy (MISC) Safe? a 9 Year Database Analysis

Abstract

<h3>Study Objective</h3> To analyze preoperative characteristics and peri-operative outcomes in patients undergoing SDD after MISC versus those discharged on post-operative day (POD) one. <h3>Design</h3> Retrospective cohort study of a national database. Patients were followed for complications for 30 days after MISC. <h3>Setting</h3> The American College of Surgeons National Surgical Quality Improvement Program (ASC NSQIP) database is a nationally validated, outcomes-based program containing peri-operative data up to 30 days after surgery. <h3>Patients or Participants</h3> Patients ≥18 years undergoing MISC from 2010-2018 were extracted using Current Procedural Terminology (CPT) codes. Patient with length of stay >1 day were excluded. <h3>Interventions</h3> Minimally invasive sacrocolpopexy. <h3>Measurements and Main Results</h3> Chi-square analysis and Student's t-test were used to analyze categorical and continuous variables respectively. Wilcoxon test was used for non-parametric data. Multivariate regression model adjusting for age, race, ethnicity, BMI, ASA class, concomitant procedures, specialty of surgeon, and baseline comorbidities including diabetes, hypertension, chronic steroid use, tobacco use, and bleeding disorders was performed. 4,180 patients were included in the analysis with 13% (n=556) and 87% (n=3,624) discharged on POD0 and POD1 respectively. No differences noted in race, ethnicity, BMI, ASA class, and concomitant sling procedures among both groups. Patients in the SDD group were younger (60.1 vs 61.9 years, p<0.01), had shorter operative time (158 vs 183 min, p<0.005), were more likely to have a gynecologist surgeon (84.0 vs 79.2%, p=0.001), were less likely to have hypertension (35.8 vs 42.1%, p=0.005) and concomitant hysterectomy (3 vs 23%, p<0.005). No differences in composite or individual complication rates were noted between SDD versus discharge on POD1. Rates of common complications were - UTI (2%), readmission (2%), reoperation (1%), superficial surgical site infection (SSI) (0.5%), organ space SSI (0.2%), and deep incisional SSI (0.04%) with no differences between the groups. <h3>Conclusion</h3> SDD is safe after MISC and is not associated with increased risk of peri-operative complications including readmissions and reoperations.