Same-day Discharge Research Articles

Total Joint Arthroplasty Patient Demographics Before and after COVID-19 Elective Surgery Restrictions.

In 2020, the COVID-19 pandemic caused cessation of non-emergent total joint arthroplasty (TJA, referring to total hip and total knee arthroplasty) operations between mid-March and April 2020. The purpose of this study is to analyze effects and potential disparities in access to care due to the COVID-19 restrictions. A database was used to examine demographics of patients undergoing TJA from May-December 2019 (Pre-COVID-19) and May-December 2020 (Post-COVID-19 restrictions). Categorical covariates were summarized by reporting counts and percentages and compared using Fisher exact tests. Continuous covariates were summarized by reporting means and standard deviations. Two-sample t-tests were used for continuous covariates. Equality of TJA counts by year were tested using a test of proportions. There were more TJA procedures performed during the post-COVID-19 period in 2020 vs pre-COVID19 (1151 vs. 882, p<.001). There was an increase in the relative percentage of THAs vs. TKAs performed in 2020 vs 2019 (26.9% vs 18.8%, p<.001), and an increase in patients with Medicaid with a decrease in private insurance (p=.043). The average length of stay was shorter in 2020 with a greater percentage of TJAs performed outpatient ( p<.001). There were no differences in patient sex, race, BMI, smoking status, or age between the two periods. A relative increase in THA procedures, an increase in patients with Medicaid and decrease in private insurance, and a decreased length of stay were seen post COVID-19 restrictions. These trends may reflect pandemic-related changes in insurance status as well as the growing shift to same-day discharge.

MP71-12 AMBULATORY ARTIFICIAL URINARY SPHINCTER AND MALE URETHRAL SLING SURGERY HAVE SIMILAR 30-DAY COMPLICATION, REOPERATION, AND READMISSION RATES: A NATIONAL ANALYSIS, 2016-2019

You have accessJournal of UrologyCME1 Apr 2023MP71-12 AMBULATORY ARTIFICIAL URINARY SPHINCTER AND MALE URETHRAL SLING SURGERY HAVE SIMILAR 30-DAY COMPLICATION, REOPERATION, AND READMISSION RATES: A NATIONAL ANALYSIS, 2016-2019 Krishna Ravivarapu, Micah Levy, Christopher Connors, Daniel Wang, Chih Peng Chin, Evan Garden, Olamide Omidele, Francisca Larenas, and Michael Palese Krishna RavivarapuKrishna Ravivarapu More articles by this author , Micah LevyMicah Levy More articles by this author , Christopher ConnorsChristopher Connors More articles by this author , Daniel WangDaniel Wang More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Evan GardenEvan Garden More articles by this author , Olamide OmideleOlamide Omidele More articles by this author , Francisca LarenasFrancisca Larenas More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have compared complication rates following artificial urinary sphincter implantation (AUS) and male urethral sling placement (MUS). To the best of our knowledge, this is the first population-based comparative analysis of ambulatory AUS and MUS. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement database from 2016 to 2019 was used to identify all patients who underwent AUS (CPT 53445) and MUS (CPT 53440). Ambulatory surgery patients were selected based on a total hospital length of stay of zero days. We compared baseline characteristics, complication rates, reoperations, and readmissions between ambulatory AUS and MUS cohorts. Multivariate regression analysis controlling for available demographic and comorbidity data was used to evaluate the relationship between procedure type and adverse events. RESULTS: A total of 963 AUS and 550 MUS surgeries were analyzed. Of these, surgery was performed on an ambulatory basis for 27.7% (n=267) of AUS and 60.5% (n=333) of MUS cases. There were no statistically significant changes in utilization of same-day discharge for AUS (p=0.33) or MUS (p=0.82) from 2016 to 2019. Compared to patients undergoing ambulatory MUS, ambulatory AUS patients were more likely to be over 65 years old (74.7% vs. 64.9%), White race (77.7% vs. 58.9%), hypertensive (63.8% vs. 55.6%), insulin-dependent (9.4% vs. 3.9%), chronic steroid users (5.3% vs. 2.1%), and diagnosed with disseminated cancer (2.3% vs. 0.3%) (all p<0.05). There was no difference in overall 30-day complication rates (3.4% AUS vs. 3.3% MUS, p=0.91). Likewise, there were no significant differences in Clavien-Dindo I/II rates (3.0% AUS vs. 2.4% MUS, p=0.64) or Clavien-Dindo IV rates (0.4% AUS vs. 0.9% MUS, p=0.44). There was no significant difference in 30-day reoperation rates (2.3% AUS vs. 1.8% MUS, p=0.69). There was a trend towards higher rates of 30-day readmission rate for ambulatory AUS at 3.4% versus 1.5% for MUS (p=0.13). However, after controlling for patient demographics and comorbidities on multivariate regression analysis, undergoing ambulatory AUS versus MUS did not confer significantly increased odds of 30-day complication (OR 0.71, 95% CI 0.25-1.97, p=.51), reoperation (OR 1.03, 95% CI 0.30-3.61, p=.96), or readmission (OR 1.75, 95% CI 0.45-6.77, p=.42). CONCLUSIONS: Using a national database, we found no significant differences in 30-day complication, reoperation, or readmission rates between ambulatory AUS and MUS. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1019 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Krishna Ravivarapu More articles by this author Micah Levy More articles by this author Christopher Connors More articles by this author Daniel Wang More articles by this author Chih Peng Chin More articles by this author Evan Garden More articles by this author Olamide Omidele More articles by this author Francisca Larenas More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

Same-Day Discharge for Thyroidectomy: Why the Holdup?

Clinical ThyroidologyVol. 35, No. 4 Thyroid SurgerySame-Day Discharge for Thyroidectomy: Why the Holdup?Eric Walser and Jesse D. PasternakEric Walser Division of General Surgery, Division of Critical Care, Western University Schulich School of Medicine, London Health Sciences Center, London, Ontario, Canada. Section of Endocrine Surgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada.Search for more papers by this author and Jesse D. Pasternak Division of General Surgery, Division of Critical Care, Western University Schulich School of Medicine, London Health Sciences Center, London, Ontario, Canada. Section of Endocrine Surgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada.Search for more papers by this authorPublished Online:11 Apr 2023https://doi.org/10.1089/ct.2023;35.167-169AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 35Issue 4Apr 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Eric Walser and Jesse D. Pasternak.Same-Day Discharge for Thyroidectomy: Why the Holdup?.Clinical Thyroidology.Apr 2023.167-169.http://doi.org/10.1089/ct.2023;35.167-169Published in Volume: 35 Issue 4: April 11, 2023PDF download

Greetings From the Editor of Clinical Thyroidology

Clinical ThyroidologyVol. 35, No. 4 Greetings from the EditorFree AccessGreetings From the Editor of Clinical ThyroidologyPublished Online:11 Apr 2023https://doi.org/10.1089/ct.2023;35.129-130AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Our editorial team is thrilled to share this month's issue of Clinical Thyroidology, which provides an in-depth look at recent studies spanning the topics of thyroid laboratory testing, thyroid disease and pregnancy, pediatric thyroidology, thyroid nodules, and thyroid cancer.The issue begins with a review by Drs. Sawan Vijay Rupani and Anupam Kotwal of a study on the use of age- and sex-specific thyroid function test ranges to more appropriately diagnose subclinical thyroid dysfunction. Moving to the topic of thyroid and pregnancy, Drs. Ricardo Villela and Ricardo Correa summarize a study examining the role of thyroid autoantibodies on thyroid function in women during preconception and gestation. Relatedly, Drs. Sofie Bliddal and Ulla Feldt-Rasmussen provide their perspective on a study reporting the challenges of antithyroid drug use in women with Graves’ disease during pregnancy. Our pediatric thyroidologist editorial board member, Dr. Gary Francis, wraps up this first group of papers with his summary on a study of macro-thyrotropin in the consideration of congenital hypothyroidism.Moving on to thyroid nodules and thyroid cancer, Drs. George Taylor and Lindsay Kuo discuss a study assessing the accuracy of the Bethesda cytopathologic reporting system in indeterminate thyroid lesions. On the provocative topic of cancer prevention, Dr. Joanna Klubo-Gwiezdzinska reviews a study that tackles this question by studying a healthy lifestyle. Drs. David Toro-Tobon and Omar El Kawkgi then discuss a Korean population-based epidemiologic study on the risk of secondary malignancies associated with radioactive iodine treatment for thyroid cancer. The topic of postoperative serum calcitonin levels as a predictor of medullary thyroid cancer behavior is discussed in a study reviewed by Dr. Christopher Rowe. For all patients with a diagnosis of thyroid cancer, the potential unexpected effects of initial treatment are important to consider. Dr. Jie Liu reviews a study that surveyed thyroid cancer patients to assess changes in quality-of-life measures associated with their treatment. Relatedly, Drs. Erivelto Volpi and Leonardo Rangel summarize a study reporting the risk of hypoparathyroidism and impacts on quality of life among thyroid cancer survivors. Finally, Drs. Eric Walser and Jesse Pasternak share their perspective on a study examining the role of same-day discharge with patients undergoing thyroid surgery.We remain active on our various social media channels, and I invite our readers to further engage with us there. In these channels, we recap the featured highlights from each month's issue and discuss other topics related to the latest clinical thyroid literature. All are welcome to join us at:Twitter:https://twitter.com/clinicalthyroid(@clinicalthyroid)Facebook:https://www.facebook.com/ThyroidAssociationLinkedIn:https://www.linkedin.com/company/american-thyroid-associationYoutube:https://www.youtube.com/user/thyroidorgI also thank the editorial board of Clinical Thyroidology for the Public [CTFP] (https://www.thyroid.org/patient-thyroid-information/ct-for-patients), as led by Dr. Alan Farwell, for their work in providing short summaries of our Clinical Thyroidology articles each month. These quicker reads are helpful to patients and to the general public who are interested in learning more about recently published studies in the clinical thyroid literature.We will continue to provide reviews, commentaries, editorials, and perspectives of the most relevant clinical thyroid studies from the published literature. Guidelines for submitting Letters to the Editor and select Guest Editorials that cover timely and innovative aspects of clinical thyroid disease management may be found at https://home.liebertpub.com/publications/clinical-thyroidologyand174/623/for-authors.Thank you again for your interest in Clinical Thyroidology. Please feel free to send me any questions or comments at clinicalthyroidology@thyroid.org.Warmest regards,Angela M. Leung, MD, MScEditor-in-Chief, Clinical ThyroidologyFiguresReferencesRelatedDetails Volume 35Issue 4Apr 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Greetings From the Editor of Clinical Thyroidology.Clinical Thyroidology.Apr 2023.129-130.http://doi.org/10.1089/ct.2023;35.129-130Published in Volume: 35 Issue 4: April 11, 2023PDF download

Voiding Trial Outcomes After Prolapse Surgery: Before Versus During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) has changed practice patterns resulting in same-day discharge after most urogynecologic surgical procedures. We aimed to determine if COVID-19 practice patterns changed patients' voiding trial (VT) results after surgery. This is a retrospective cohort study of women undergoing urogynecologic surgery at an academic tertiary care center. We compared patients who had surgery between January 1, 2019, and February 28, 2020, (pre-COVID, discharged on postoperative day [POD] 1) with those who underwent surgery between January 1, 2021, and February 28, 2022, (during COVID, discharged on POD 0 or POD 1). Demographics, surgical characteristics, and VT results were compared using nonparametric tests. A logistic regression was performed to adjust for confounders. P value <0.05 was considered statistically significant. A total of 237 patients were included. Patients were mostly White, older than 65 years (interquartile range, 56-73 years), and had a median parity of 2 (interquartile range, 2-3). Approximately 31% of patients in the pre-COVID group failed their VT, whereas 38% in the during-COVID group failed ( P = 0.275). Moreover, 40.5% of women discharged the day of surgery failed their VT ( P = 0.172). Compared with the pre-COVID group, more patients in the during-COVID group and those discharged on POD 0 contacted their surgeons with questions postoperatively (20.5% vs 35.0% and 35.4%, P = 0.014 and 0.022, respectively). Rates of urinary tract infection were similar by period and discharge day ( P > 0.05). There was no statistical association between day of discharge or the COVID-19 pandemic and VT results. Neither day of discharge nor the presence of the COVID-19 pandemic had a significant effect on postoperative outcomes, including urinary retention, after urogynecologic surgery. Same-day discharge is appropriate for most patients.

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

BackgroundDespite advancements in minimally invasive repair of pectus excavatum (MIRPE), Nuss procedure, postoperative pain control remains challenging. This report covers a multimodal regimen using bilateral single-shot paravertebral block (PVB) and bilateral thoracoscopic intercostal nerve (T3–T7) cryoablation, leading to significant reduction in length of stay (LOS) and high rate of same-day discharge.Methods This is a comparative study of pain management protocols for patients undergoing the Nuss procedure at a single center from 2016 through 2020. All patients underwent the the same surgical technique for the treatment of pectus excavatum at a single center. Patients received bilateral PVB with continuous infusion (Group 1, n = 12), bilateral PVB with infusion and right-side cryoablation (Group 2, n = 9), or bilateral single-shot PVB and bilateral cryoablation (Group 3, n = 17). The primary outcome was LOS with focus on same-day discharge, and the secondary outcome was decreased opioid usage.ResultsEleven of 17 patients in Group 3 (65%) (bilateral single-shot PVB and bilateral cryoablation) were discharged the same day as surgery. The remaining Group 3 patients were discharged the following day with no complications or interventions. Compared to Group 1 (no cryoablation), Group 3 had shorter LOS (median 4.4 days vs. 0.7 days, respectively, p < 0.001) and significantly decreased median opioid use on the day of surgery (0.92 mg/kg vs. 0.47 mg/kg, p = 0.006).Conclusion Findings demonstrate the feasibility of multimodal pain management for same-day discharge after the Nuss procedure. Future multisite studies are needed to investigate the superiority of this approach to established methods.Level of EvidenceIII.

Same-Day Discharge and 30-Day Readmissions After Atrial Fibrillation Ablation Before and During the COVID-19 Pandemic

Same-Day Discharge and 30-Day Readmissions After Atrial Fibrillation Ablation Before and During the COVID-19 Pandemic

Same day discharge versus overnight observation following chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO registry

Same day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We evaluated the clinical, angiographic, and procedural characteristics of patients discharged the same day versus those kept for overnight observation in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436). Of the 7181 patients who underwent CTO PCI, 943 (13%) had SDD. The SDD rate increased from 3% in 2015 to 21% in 2022. Patients with SDD were less likely to have a history of heart failure (21% vs. 26%, p = 0.005), chronic lung disease (10% vs. 15%, p = 0.001), or anemia (12% vs. 19%, p < 0.001). Technical success (87% vs. 88%, p = 0.289) was similar, but in-hospital major adverse cardiovascular events (0.0% vs. 0.4%, p = 0.041) were lower in SDD. In multivariable logistic regression analysis, prior myocardial infarction odds ratio (OR): 0.71 (95% confidence interval [CI]: 0.59-0.87, p = 0.001), chronic lung disease OR: 0.64 (95% CI: 0.47-0.88, p = 0.006), and increasing procedure time OR: 0.93 (95% CI: 0.91-0.95, p < 0.001, per 10-min increase) were associated with overnight observation, while radial-only access OR: 2.45 (95% CI: 2.03-2.96, p < 0.001) had the strongest association with SDD. In the SDD, 2 (0.4%) of 514 patients were readmitted, due to retroperitoneal bleeding (n = 1) and ischemic stroke (n = 1). The overall frequency of SDD after CTO PCI was 13% and has been increasing over time. SDD is feasible in select patients following CTO PCI, and radial-only access had the strongest association with SDD.

Satisfaction With Same-Day Discharge After Laparoscopic Appendectomy for Nonperforated Appendicitis

IntroductionSame-day discharge (SDD) after laparoscopic appendectomy for acute nonperforated appendicitis is safe, without an increased rate of postoperative complications, emergency department visits, or readmissions. We aimed to evaluate caregiver satisfaction with this protocol. MethodsPatients discharged on the day of laparoscopic appendectomy for nonperforated acute appendicitis were identified between January 2022 and August 2022. Surveys to evaluate satisfaction with the protocol were distributed to the caregivers via email or text message 96 h after discharge. Telephone surveys were conducted if there were no responses to the initial online survey. The surveys assessed comfort with SDD, postoperative pain control adequacy, postoperative provider contact, and overall satisfaction. The protocol focused on avoidance of narcotics in the postoperative period and immediate return to a regular diet. ResultsA total of 255 cases of nonperforated acute appendicitis underwent SDD. The survey response rate was 50.6% (n = 129). Most respondents were Caucasian (69.0%, n = 89) and male (51.9%, n = 67) with a median age of 12.0 y (IQR 8.9,14.7). The median postoperative length of hospital stay was 3.8 h (interquartile range [IQR] 3.2,4.8). The overall satisfaction rate was 91.5%, with 118 caregivers feeling satisfied with SDD. Most caregivers felt comfortable with the SDD protocol (89.9%, n = 116), with 22.5% (n = 29) calling a medical provider postoperatively. Approximately nine out of 10 caregivers reported that pain was adequately controlled (91.5%, n = 118). In contrast, those that were dissatisfied reported issues with pain control and anxiety with SDD after a surgical procedure. ConclusionsCaregiver satisfaction and comfort with same-day discharge following laparoscopic appendectomy is high with appropriate anticipatory guidance and preoperative education.

Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 2: Assessment of Surgical Safety in Medicare Beneficiaries.

(1) Background: The clinical benefits and procedural efficiencies of performing minimally invasive fusion procedures, such as transforaminal lumbar interbody fusion (TLIF), in the ambulatory surgery center (ASC) are becoming increasingly well established. Currently, Medicare does not provide reimbursement for its beneficiaries eligible for TLIF in the ASC due to a lack of evidence regarding procedural safety. However, the initiation of the Hospital Without Walls program allowed for traditional hospital procedures to be relocated to other facilities such as ASCs, providing a unique opportunity to evaluate the utility of TLIF in the ASC in Medicare-age patients. (2) Methods: This single-center, retrospective study compared baseline characteristics, intraoperative variables, and 30-day postoperative safety outcomes between 48 Medicare-age patients undergoing TLIF in the ASC and 48 patients having the same procedure as hospital in-patients. All patients had a one-level TLIF using the VariLift®-LX expandable lumbar interbody fusion device. (3) Results: There were similar patient characteristics, procedural efficiency, and occurrence of clinical 30-day safety events between the two study groups. However, there was a marked and statistically significant difference in the median length of stay favoring TLIF patients treated in the ASC (23.9 h vs. 1.6 h, p = 0.001). All ASC-treated patients were discharged on the day of surgery. Postoperative visits to address adverse events were rare in either group. (4) Conclusions: These findings provide evidence that minimally invasive TLIF can be performed safely and efficiently in the ASC in Medicare-age patients. With same-day discharge, fusion procedures performed in the ASC offer a similar safety and more attractive cost-benefit profile for older patients than the same surgery undertaken in the traditional hospital setting. The Centers for Medicare and Medicaid Services should strongly consider extending the appropriate reimbursement codes (CPT ® 22630, 22633) for minimally invasive TLIF and PLIF to the ASC Covered Procedure List so that Medicare-age patients can realize the clinical benefits of surgeries performed in this setting.

Disparities in Utilization of Same-Day Discharge Following Appendectomy in Children

IntroductionDisparities in the delivery of pediatric surgical care exist for racial and ethnic minority groups. Utilization of same-day discharge (SDD) following appendectomy for acute, uncomplicated appendicitis is increasing; however, rates among diverse populations have not been explored to evaluate equitable care delivery and healthcare utilization. Our objective was to determine whether race and ethnicity are associated with rates of SDD and postdischarge healthcare utilization. We hypothesized that racial and ethnic minority groups would have lower rates of SDD. MethodsThis retrospective cohort study used data from the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program-Pediatric clinical registry and included children who underwent appendectomy. Patients with complicated appendicitis were excluded. Primary exposure was racial or ethnic group. The primary outcome was SDD, and secondary outcomes included postdischarge emergency department visits and hospital readmissions. ResultsOf 37,579 simple appendicitis patients, SDD after appendectomy occurred in 10,012 (26.6%). On multivariable analysis, Black or African American race was associated with lower likelihood of SDD (adjusted odds ratio [aOR]: 0.85; 95% confidence interval [95% CI]:0.79-0.92; P < 0.0001). Hispanic ethnicity was associated with higher likelihood of SDD (aOR: 1.19; 95% CI: 1.12-1.25; P < 0.0001). Likelihood of postoperative emergency department visits was higher in Black or African American patients (aOR: 1.36; 95% CI: 1.14-1.62; P < 0.001) and Hispanic patients (aOR: 1.37; 95% CI: 1.12-1.58; P < 0.0001). Hospital readmission rates were similar across groups. ConclusionsRates of SDD following appendectomy vary among racial and ethnic groups. Interventions to achieve equitable healthcare delivery including SDD after appendectomy are needed.

Outpatient Deep Brain Stimulation Surgery Is a Safe Alternative to Inpatient Admission.

Deep brain stimulation (DBS) is usually performed as an inpatient procedure. The COVID-19 pandemic effected a practice change at our institution with outpatient DBS performed because of limited inpatient and surgical resources. Although this alleviated use of hospital resources, the comparative safety of outpatient DBS surgery is unclear. To compare the safety and incidence of early postoperative complications in patients undergoing DBS procedures in the outpatient vs inpatient setting. We retrospectively reviewed all outpatient and inpatient DBS procedures performed by a single surgeon between January 2018 and November 2022. The main outcome measures used for comparison between the 2 groups were total complications, length of stay, rate of postoperative infection, postoperative hemorrhage rate, 30-day emergency department (ED) visits and readmissions, and IV antihypertensive requirement. A total of 44 outpatient DBS surgeries were compared with 70 inpatient DBS surgeries. The outpatient DBS cohort had a shorter mean postoperative stay (4.19 vs 39.59 hours, P = .0015), lower total complication rate (2.3% vs 12.8%, P = .1457), and lower wound infection rate (0% vs 2.9%, P = .52) compared with the inpatient cohort, but the difference in complications was not statistically significant. In the 30-day follow-up period, ED visits were similar between the cohorts (6.8% vs 7.1%, P = .735), but no outpatient DBS patient required readmission, whereas all inpatient DBS patients visiting the ED were readmitted ( P = .155). Our study demonstrates that DBS can be safely performed on an outpatient basis with same-day hospital discharge and close continuous monitoring.

Same-day discharge robot-assisted laparoscopic prostatectomy: feasibility, safety and patient experience.

To report a single centre's experience of the feasibility, safety and patient acceptability of same-day discharge robot-assisted laparoscopic prostatectomy (RALP). Between June 2015 and December 2021, a total of 180 pre-selected consecutive patients underwent RALP with the intention to discharge on the same day as surgery. Cases were performed by two surgeons. An enhanced recovery after surgery (ERAS) programme was used. The feasibility of same-day discharge was analysed, along with the complication rate, oncological outcomes, and postoperative patient experience. Of 180 patients, 169 (93.8%) were successfully discharged on the same day as surgery. The median (range) age was 63( 44-74)years. The median (range) console time was 97(61-256)min and blood loss was 200 (20-800) mL. The resection specimen pathology results were: pT2 69.4%, pT3a 24.4% and pT3b 6.5%. With regard to Gleason Grade Group (GGG), 25.9% had GGG 1, 65.7% had GGG 2-3 and 8.4% had GGG 4-5 disease. Positive surgical margins were present in 25 cases (14.7%), 18 (15.5%) of which occurred in pT2 cases, and seven (13.4%) in pT3 cases. There were no early (<90 days) biochemical relapses (defined as prostate-specific antigen level>0.2ng/mL). The 30-day readmission rate was 3%. A total of 13 early (0-30 days) complications were observed, five of which were Clavien-Dindo grade≥3, however, none of these would have been avoided had the patient remained in hospital on the first postoperative night. Of 121 consecutive patients, 107 (88%) returned a satisfaction questionnaire, and 92% of responders stated they preferred recovery at home, with 94% stating they felt ready to go home. Robot-assisted laparoscopic prostatectomy combined with an ERAS programme allows patients to be safely discharged home on the same day of their surgery. This is a feasible option, well-liked by patients, with morbidity and oncological outcomes similar to non-day-case or 23 h stay RALP.

Implementation of Ireland's first state-funded day-case total hip arthroplasty programme.

Over the last two decades, many elective procedures have transitioned to day-case surgery thanks to the introduction of 'enhanced recovery' protocols. Only recently has total hip arthroplasty been considered a candidate for day-case surgery, as it was once associated with significant pain, mobility impairment and prolonged postoperative recovery. The National Orthopaedic Hospital Cappagh became the first public hospital in Ireland to set up a day-case total hip arthroplasty service in June 2018, and since then has performed over 109 such cases. We outline our day-case total hip arthroplasty pathway, with specific focus on anaesthetic considerations. We report rates of failed discharge and readmission. We achieved successful same-day discharge in 90.8% of our first 109 cases. Readmission rate was 4.6%. Our experience of implementing a day-case total hip arthroplasty pathway was highly positive and congruent with expectations from the literature. With appropriate patient selection and education, day-case total hip arthroplasty is not just safe, but of benefit to both patients and healthcare systems.

Distance and resources in vulnerable populations: understanding access barriers to outpatient shoulder arthroplasty

BackgroundOutpatient shoulder arthroplasty is advantageous in appropriately selected patients, and tools for performing selection are available. Whether vulnerable populations benefit from outpatient surgery despite being appropriate candidates clinically is unclear. We hypothesized that patient travel distance and resource level impact the ability to complete accelerated care pathways. MethodsA retrospective cohort of patients undergoing anatomic/reverse total shoulder arthroplasty at 2 geographically diverse, high-volume tertiary referral centers was created; 5406 cases were stratified into cohorts based on travel distance (0-49, 50-99, 100-150, and >150 miles). Sociodemographic, median income, and comorbidity data were collected. Short inpatient stay was utilized as a proxy for appropriateness for same-day discharge. Overall length of stay (LOS) and unplanned 90-day readmissions were collected as secondary outcomes. ResultsFour thousand one hundred one patients traveled 0-49 miles, 695 traveled 50-99 miles, 313 traveled 100-149 miles, and 297 traveled >150 miles for shoulder arthroplasty. Few significant differences in sociodemographic/comorbidity burdens were observed between distance cohorts. Increased distance outside of the immediate area (>50 miles) was significantly associated with decreased likelihood of short inpatient stay (P < .001) and increased LOS (P = .027) for Institution #1. For Institution #2, those in the shortest and longest distance groups had the shortest LOS (P = .018). Overall, patients living <50 miles had the highest income levels. A bi-modal income distribution was observed for Institution #1, while income decreased as distance increased for Institution #2. Unplanned 90-day readmission rates were not significantly different for either institution. DiscussionOverall, when examining demographic variables for the entire cohort representing both institutions, patient travel distance to a high-volume tertiary orthopedic center did not appear to be the primary driver for variability in early postoperative outcomes (ie, 90-day readmissions, short stay, LOS). For Institution 1, patients living further from surgery centers underwent short inpatient stay at lower rates relative to those nearby. Importantly, lower resource levels were seen as distance increased for both institutions, potentially limiting the ability to manage same-day discharge without additional assistance despite being clinically appropriate candidates for outpatient arthroplasty. Therefore, providing overnight lodging options and perioperative support for vulnerable populations may minimize disparities in access, while serving as a lower-cost-option.

Impact of Anesthetic Choice on Time to Discharge for Same-Day Discharge Joints

BackgroundAs total joint arthroplasty programs continue to move towards same-day discharge (SDD), time to discharge is an increasingly important performance indicator. The primary objective of this study was to determine the impact of the choice of anesthetic on the time to discharge after SDD primary hip and knee arthroplasty. MethodsA retrospective chart review was conducted within our SDD arthroplasty program, with 261 patients identified for analysis. Baseline characteristics, length of surgery, anesthetic drug, dose, and perioperative complications were extracted and recorded. The time from the patient leaving the operating room to physiotherapy assessment and from the operating room to discharge were recorded. These were referred to as ambulation time and discharge time, respectively. ResultsThe ambulation time was significantly reduced when hypobaric lidocaine was used in a spinal block compared to isobaric or hyperbaric bupivacaine—135 minutes (range, 39 to 286), 305 minutes (range, 46 to 591), and 227 minutes (range, 77 to 387), respectively—(P < .0001). Similarly, the discharge time was also significantly lower with hypobaric lidocaine compared to isobaric bupivacaine, hyperbaric bupivacaine, and general anesthesia—276 minutes (range, 179 to 461), 426 minutes (range, 267 to 623), 375 minutes (range, 221 to 511), and 371 minutes (range, 217 to 570), respectively—(P < .0001). No cases of transient neurologic symptoms were reported. ConclusionPatients receiving a hypobaric lidocaine spinal block experienced significantly reduced ambulation time and time to discharge compared to other anesthetics. Surgical teams should feel confident in using hypobaric lidocaine during spinal anesthesia as it is rapid and efficacious.

Same-Day Mastectomy and Immediate Prosthetic Breast Reconstruction: A 12-Year National Database Analysis and Early Postoperative Outcomes.

Coronavirus disease of 2019 and rising health care costs have incentivized shorter hospital stays after mastectomies with immediate prosthetic reconstruction. The purpose of this study was to compare postoperative outcomes following same-day and non-same-day mastectomy with immediate prosthetic reconstruction. A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2019 was performed. Patients who underwent mastectomies and immediate reconstruction with tissue expanders or implants were selected and grouped based on length of stay. Univariate analysis and multivariate regression were performed to compare 30-day postoperative outcomes between length-of-stay groups. A total of 45,451 patients were included: 1508 had same-day surgery (SDS) and 43,942 were admitted for 1 or more night (non-SDS). There was no significant difference in overall 30-day postoperative complications between SDS and non-SDS following immediate prosthetic reconstruction. SDS was not a predictor of complications (OR, 1.1; P = 0.346), whereas tissue expander reconstruction decreased odds of morbidity compared with direct-to-implant reconstruction (OR, 0.77; P < 0.001). Among patients who had SDS, smoking was significantly associated with early complications on multivariate analysis (OR, 1.85; P = 0.010). This study provides an up-to-date assessment of the safety of mastectomies with immediate prosthetic breast reconstruction that captures recent advancements. Postoperative complication rates are similar between same-day discharge and at least 1-night stay, suggesting that same-day procedures may be safe for appropriately selected patients. Therapeutic, III.

Enhanced Recovery After Surgery Protocol Allows Safe Same-Day Discharge in Expander Based and Oncoplastic Breast Reconstruction.

Data after enhanced recovery after surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes after same-day discharge in tissue-expander immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction. A single-institution retrospective review of TE-IBR patients from 2017 to 2022 and oncoplastic breast reconstruction patients from 2014 to 2022 was performed. Patients were divided by procedure and recovery pathway: group 1 (TE-IBR, overnight admission), group 2 (TE-IBR, ERAS), group 3 (oncoplastic, overnight admission), and group 4 (oncoplastic, ERAS). Groups 1 and 2 were subdivided by implant location: groups 1a (prepectoral) and 1b (subpectoral), and groups 2a (prepectoral) and 2b (subpectoral). Demographics, comorbidities, complications, and reoperations were analyzed. A total of 160 TE-IBR patients (group 1, 91; group 2, 69) and 60 oncoplastic breast reconstruction patients (group 3, 8; group 4, 52) were included. Of the 160 TE-IBR patients, 73 underwent prepectoral reconstruction (group 1a, 25; group 2a, 48), and 87 underwent subpectoral reconstruction (group 1b, 66; group 2b, 21). There were no differences in demographics and comorbidities between groups 1 and 2. Group 3 had a higher average body mass index than group 4 (37.6 vs 32.2, P = 0.022). There was no significant difference between groups 1a and 2a or between groups 1b and 2b in rates of for rates of infection, hematoma, skin necrosis, wound dehiscence, fat necrosis, implant loss, or reoperations. Group 3 and group 4 showed no significant difference in any complications or in reoperations. Notably, no patients in same-day discharge groups required unplanned hospital admission. Many surgical subspecialities have successfully adopted ERAS protocols into their patient care and have shown both its safety and feasibility. Our research shows that same-day discharge in both TE-IBR and oncoplastic breast reconstruction does not increase risk for major complications or reoperations.

Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis.

Length of stay after bariatric surgery has progressively shortened. Same-day discharge (SDD) has been reported for the 2 most common bariatric procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to evaluate the safety and success of SDD following SG and RYGB. Systematic literature search on SDD after bariatric surgery was conducted in Medline, Cochrane library, Google Scholar, and Embase. SDD was defined as discharging the patient during the day of the bariatric operation, without an overnight stay. The primary outcomes of interest were successful SDD, readmission, and morbidity rates. The secondary endpoints included reoperation and mortality rates. A proportion meta-analysis was performed to assess the outcomes of interest. A total of 14 studies with 33,403 patients who underwent SDD SG (32,165) or RYGB (1238) were included in the qualitative synthesis. Seven studies with 5000 patients who underwent SDD SG were included in the quantitative analysis, and pooled proportions (PPs) were calculated for the outcomes of interest. The SDD success rate was 63%-100% (PP: 99%) after SG and 88%-98.1% after RYGB. The readmission rate ranged from .6% to 20.8% (PP: 4%) after SDD SG and 2.4%-4% after SDD RYGB. Overall morbidity, reoperation, and mortality were 1.1%-10% (PP:4%), .3%-2.1% (PP: 1%), and 0%-.1% (PP: 0%), respectively, for SDD SG, and 2.5%-4%,1.9%-2.5%, and 0%-.9%, respectively, for SDD RYGB. SDD after SG seems feasible and safe. The outcomes of SDDRYGB seem promising, but the evidenceis stilllimitedto draw definitive conclusions. Selection criteria and perioperative protocolsmust be standardized to adequately introduce this practice.

Abstract P6-05-58: Comparing Patient-Reported Outcomes for Same-day Discharge and Inpatient Admission After Mastectomy

Abstract Background: Same-day discharge after mastectomy has been demonstrated to be safe in appropriately selected candidates. However, the association between same-day discharge after mastectomy and quality of life (QOL) is unclear. Patient-reported outcome (PRO) measures represent important indicators of QOL among patients undergoing treatment for breast cancer. In this study, we aimed to evaluate the effect of same-day discharge after mastectomy on PROs. Methods: We performed a retrospective review of a prospectively collected, longitudinal PRO registry of female breast cancer patients treated at an academic breast center between June 2019 and June 2022. Patients were invited to complete the BREAST-Q module, a validated PRO questionnaire measuring QOL domains such as psychosocial wellbeing, physical wellbeing, satisfaction with their surgeon, and satisfaction with their medical team. Preoperative and 2-week postoperative questionnaire responses were analyzed in this study. Patients who had a mastectomy with or without reconstruction were included in this analysis. Those who underwent immediate reconstruction with autologous tissue were excluded as these operations are not conducive to same-day discharge. Patients were divided into two groups: the first was discharged on the date of surgery while the second was admitted to the hospital for a minimum of one night. Clinical and demographic factors were collected from a review of the electronic medical record. The primary endpoints were mean satisfaction scores as well as differences between postoperative and preoperative scores for the psychosocial and physical wellbeing domains. T-tests were used to evaluate differences between groups. A multiple regression model was fit to adjust for the effects of relevant clinical and demographic factors. Results: A total of 104 patients within the registry underwent mastectomy during the study period and were offered questionnaires. Of these, 58 completed both the preoperative and 2-week postoperative questionnaire (56% response rate); 20 (34%) in the same-day discharge group and 38 (66%) in the inpatient admission group. The groups were similar in age, stage, American Society of Anesthesiologists’ classification group, body mass index, frequency of unplanned readmission or reoperation, and receipt of bilateral mastectomy, axillary lymph node dissection, post-mastectomy reconstruction, and neoadjuvant chemotherapy. Mean patient satisfaction scores and mean changes in psychosocial and physical wellbeing scores were similar between the groups 2 weeks after surgery (Table 1). After controlling for age, type of reconstructive operation, receipt of unplanned reoperation, and preoperative score, same-day discharge did not have a significant effect on satisfaction with the surgeon (Beta=-4.3, p=0.37), satisfaction with the medical team (Beta=0.2, p=0.97), physical wellbeing score (Beta=-0.1, p=0.99), or psychosocial wellbeing score (Beta=8.0, p=0.15). Conclusions: Patients who are discharged from the hospital on the same day of a mastectomy display similar levels of satisfaction with their care team and similar short-term trends in physical and psychosocial wellbeing compared to those who are admitted to the hospital. While further data are being accrued, these early results suggest patients tolerate same-day discharge after mastectomy well. Table 1 Patient-reported outcomes at 2 weeks after mastectomy for patients discharged on the date of surgery compared to those admitted inpatient Citation Format: Sudheer Vemuru, Kathryn Colborn, Laura Leonard, Victoria Huynh, Christodoulos Kaoutzanis, Justin Cohen, David Mathes, Nicole Christian, Gretchen M. Ahrendt, Christine M. Fisher, Simon Kim, Sarah Tevis. Comparing Patient-Reported Outcomes for Same-day Discharge and Inpatient Admission After Mastectomy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-58.