Prevalence of and Preoperative Risk Factors for Unplanned Inpatient Admission Following Outpatient Gynecologic Surgery

Abstract

Study Objective We aimed to identify the prevalence of unplanned inpatient admission following outpatient gynecologic surgery. Additionally, we aimed to identify factors available preoperatively that place patients at higher risk for admission. Design Retrospective cohort study. Setting Academic medical center. Patients or Participants Women (n=2,373) age 18 and older who underwent scheduled outpatient gynecologic surgery for a benign indication between November 2017 and September 2019. Interventions Gynecologic surgery performed for benign indications. Measurements and Main Results The primary outcome was inpatient admission directly following the index surgery, defined by Medicare as spending two midnights or more in the hospital. Patients who were admitted were older (median age 50 vs 42, p There were 53 (2%) admissions directly following the index surgery. In a multivariate model adjusted for age, cardiopulmonary and pain comorbidities, ASA class, and surgery performed, the following factors were significantly associated with increased odds of inpatient admission: undergoing surgery with urogynecology (aOR 4.0; 95% CI 1.7-9.6) or gynecologic oncology (aOR 3.2; 95% CI 1.3-8.1) as compared to benign gynecology and undergoing intra-abdominal surgery (aOR 10.6; 95% CI 3.2-34.9) or prolapse surgery (aOR 6.8; 95% CI 1.8-26.1) as compared to other vulvovaginal surgery. Conclusion The prevalence of inpatient admissions following outpatient gynecologic surgery for benign indications is low. Patients undergoing surgery with urogynecology or gynecologic oncology were at higher risk for admission, even when adjusted for age, major comorbidities, and surgery performed. Due to the overall low prevalence of the outcome, larger studies are needed to further clarify what places these patient groups at higher risk.