Transition to Universal Same Day Discharge (SDD) in Times of Corona Virus Disease-19 (COVID): A Success Story

Abstract

<h3>Study Objective</h3> To evaluate success of universal SDD after minimally invasive hysterectomy. The COVID pandemic presented a unique scenario in which universal SDD was implemented abruptly across study institutions. This allowed for evaluation of patients with characteristics under-represented in SDD literature: large uteri due to leiomyoma, obesity defined as body mass index (BMI) ≥30, and later surgical end time. <h3>Design</h3> Retrospective chart review with before/after study design comparing pre-COVID to COVID cohorts. <h3>Setting</h3> High-volume, academic and academic-affiliated medical centers. Due to COVID, in the after-cohort, surgery could only be scheduled if SDD was planned. <h3>Patients or Participants</h3> Patients undergoing benign, laparoscopic or robotic-assisted hysterectomy during two 11-month periods: September 2018-July 2019 and May 2020-March 2021. <h3>Interventions</h3> Minimally invasive hysterectomy performed by three Minimally Invasive Gynecologic Surgeons. <h3>Measurements and Main Results</h3> 320 patients met inclusion criteria, 107 pre-COVID and 213 COVID. Mean age for both groups was 44.9. Patients were predominately non-Hispanic Black (40.2% pre- vs. 34.7% COVID) and non-Hispanic White (55.1% pre- vs. 63.4% COVID). Mean BMI was 33 for both groups. Pre-COVID, 2% of patients were discharged same day, whereas COVID 92% were discharged same day. Mean specimen weight was 478.2gm vs. 436.3gm for the two periods. In the COVID cohort, there was no difference in SDD success based on BMI (p 0.678), BMI <30 (49.5%), 30-39.9 (29.1%), 40-49.9 (15.3%), and ≥50 (6.1%). There was no difference in SDD success by specimen weight (p 0.077) stratified as <250gm (48.5%), 250-499gm (15.3%), or ≥500gm (36.2%). SDD success was not dependent on surgical end time (p 0.678) with end time stratified into ≤12:00 (45.4%), 12:01-14:59 (35.7%), and ≥15:00 (18.9%). There were no re-admissions in either cohort. <h3>Conclusion</h3> Abrupt transition to SDD is safe and feasible, including for patients with obese BMI and enlarged uterus. SDD success was not affected by later surgical end time.