Same day discharge after vaginal hysterectomy in the covid-19 pandemic

Abstract

To quantify the change in same day discharges following vaginal hysterectomy after the onset of the COVID-19 pandemic and evaluate the effect on postoperative outcomes. This was a retrospective cohort study of women who underwent vaginal hysterectomy at a single institution between March 2018 and August 2021. Women over age 18 who underwent vaginal hysterectomy by any gynecologic surgeon (including generalists and subspecialists) were included. Cases where a gynecologic surgeon was not listed as the primary surgeon were excluded. Primary objective measures were same day hospital discharge, with secondary measures including length of stay, concurrent procedures, comorbid conditions, and thirty-day postoperative complications. Statistical T tests for continuous variables and chi square tests for categorical variables were performed. A total of 258 women were included in the pre-pandemic cohort and 121 in the post pandemic cohort. Comparing pre-pandemic to post-pandemic groups, there was no significant difference in age (mean 55 vs. 57, p=0.21), BMI (mean 30 vs. 31, p=0.44), or rates of active malignancy (4.3% vs. 4.1% , p=0.95) or ASA Class III status (53.1% vs. 54.5%, p=0.79). While cases performed by urogynecologists (77% vs. 85%, p=0.07) and rates of apical colpopexy (58% vs. 66%, p=0.14) were similar between groups, there was a statistically significant increase in both vaginal colporrhaphy ( 44% vs. 60%, p=0.005) and surgical time (mean 166 vs 182 minutes, p=0.007) in the post-pandemic group. The post pandemic cohort was significantly more likely to discharge on POD0 (4.7% vs. 18.2%, p<0.001). However, intraoperative (5.4% vs. 5.0%, p=0.85) and postoperative (24% vs. 31%, p=0.15) complications were not significantly different, and there were not significant differences in readmissions (5.8% vs. 5.0%, p=0.73), reoperations (1.2% vs. 1.7%, p=0.70), surgical site infections3.1% vs. 5.8%, p=0.21), or mortality (1 vs. 0, p=0.49). Rates of same day discharge after vaginal hysterectomy increased following the onset of the COVID-19 pandemic, but there were no significant changes to postoperative complications, suggesting utilization of same day discharge in the appropriately selected patient is a safe strategy for management of capacity and hospital bed constraints caused by the COVID-19 pandemic.