Safety of Same-Day Discharge Versus Hospital Admission in Minimally Invasive Myomectomy

Abstract

To compare postoperative complication rates between same-day discharge and admitted patients after minimally invasive myomectomy, stratified by patient demographics and perioperative variables including fibroid burden. Retrospective cohort study SETTING: Hospitals participating in the National Surgical Quality Improvement Program database from January 2015 to December 2019. Female patients aged ≥ 18 years undergoing minimally invasive myomectomy. Patients were categorized into same-day discharge or admitted cohorts. Univariate comparison of demographics, perioperative variables, and 30-day postoperative complications was performed. Multivariate logistic regression was performed to 1) identify demographic and perioperative factors associated with admission, and 2) compare postoperative complications rates between same-day discharge versus admitted patients while adjusting for demographic and perioperative factors. 8,100 patients were captured during the study period. The overall rate of same-day discharge was 57.2% in 2015 and 65.0% in 2019. Same-day discharge rate was 64.6% for patients with a smaller fibroid burden (one to four fibroids and ≤ 250 grams, CPT 58545) and 56.8% for larger fibroid burden (≥ five fibroids or > 250 grams, CPT 58546). Age, race, American Society of Anesthesiologists classification three or four, pre-operative hematocrit <36%, hypertension, diabetes, bleeding disorder, and increasing operative time were associated with admission. After adjusting for these variables, composite postoperative complication rates were similar between admitted patients and those undergoing same-day discharge regardless of fibroid burden (adjusted OR 0.66; 95% CI 0.18-2.47 for low fibroid burden and aOR 0.91; 95% CI 0.18-4.63 for high fibroid burden). Odds of blood transfusion were higher in admitted patients with both low (aOR 9.1; 95% CI 2.27-37.04) and high (aOR 8.24; 95% CI 1.59-42.49) fibroid burdens. Same-day discharge after minimally invasive myomectomy, regardless of fibroid burden, is associated with low complication rates. Our findings may aid in shared decision making on discharge planning.