Readmission Rates in Robotic Gynecologic Surgery: A Comparison between Inpatient and Outpatient Surgery in a Large Health System

Abstract

<h3>Study Objective</h3> Current literature suggests that same-day discharge (SDD) after minimally invasive gynecologic surgery (MIGS) is feasible and associated with better perioperative outcomes. This study aims to evaluate how rates and reasons for readmission after robotic gynecologic surgery evolved over a four-year period in a large hospital system following an increase in SDD. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Health system including 11 academic and community hospitals. <h3>Patients or Participants</h3> 6,170 patients undergoing robotic gynecologic surgery during 2017-2020. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> In this study, 6,170 patients underwent robotic gynecologic surgery between 2017-2020. 3,316 patients were discharged the same day of surgery (outpatient, OP) and 2,854 were discharged on or after postoperative day 1 (inpatient, IP). 118 total patients were readmitted with a readmission rate of 3.2%. When stratified into IP and OP, the readmission rates were 4.8% and 2.3%, respectively. Over the 4-year period, the rate of SDD as a percentage of total robotic gynecologic surgeries increased by 28.3% with 59% SDD in 2020. We observed the lowest overall rate of readmission during 2020, which was also the year with the highest rate of SDD. When stratified for readmission indications, 2020 also accounted for the lowest incidence of readmission for venous thromboembolism and genitourinary complications compared to prior years. There were no readmissions for wound dehiscence or post-operative pain in this year. The rates of readmission for infection, hemorrhage, and gastrointestinal complications in 2020 were comparable to prior years in which SDD rates were lower. <h3>Conclusion</h3> As rates of SDD increased between 2017-2020, the readmission rate after robotic gynecologic surgery decreased. When stratified for specific indications, all rates for readmission in 2020 (the highest SDD year) were comparable or lower than previous years. Our study supports the current literature which demonstrates that SDD after MIGS is both safe and feasible.