30-Day Unanticipated Healthcare Encounters After Prolapse Surgery: Impact of Same Day Discharge.Am J Obstet Gynecol 2019AJ
Same day discharge is becoming increasingly common in gynecologic surgery but data is limited for frequency, setting and severity of unanticipated healthcare visits for women discharged on day of surgery after major prolapse repair.
To evaluate if discharge on the day of surgery (POD0) is associated with increased 30-day unanticipated healthcare encounters after major pelvic organ prolapse (POP) surgery compared to discharge on or after post-operative day 1 (POD1).
This is a retrospective analysis of women who underwent POP surgery by 8 FPMRS surgeons from 1/2016 - 10/2017. Unanticipated healthcare encounter was a composite variable of any visit to the office, emergency department (ED) or hospital readmission. Number of visits, visit diagnoses, and complication severity (Clavien-Dindo classification) were compared by day of discharge using χ2 tests. Multivariable analyses were performed.
Of 405 women, 258 (63.7%) were discharged POD0 and 147 (36.3%) POD1 or later. Mean age was 66 (± 11) years, body mass index was 27.9 (± 4.8) kg/m2. Most had Stage III prolapse (n=273, 67.4%). Procedures included laparoscopic or robotic sacrocolpopexy, (n=163, 40.2%), vaginal apical suspensions (n=115, 28.4%), obliterative (n=105, 25.9%), and concomitant hysterectomy (n=229, 56.5%). There was no increase in number of women with at least one unanticipated healthcare encounter within 30 days of surgery based on discharge on POD0 compared to POD1, (24.0% vs 26.5%, p= .572). Majority of visits occurred in the office (17.8% vs 19.0%, p=.760). There was no increase in 30-day readmissions (3.5% vs 4.8%, p=.527). The most common visit diagnosis was pain and accounted for 31.5% of all visits, followed by urologic and GI symptoms. Diagnoses and complication severity did not vary by day of discharge, except women discharged POD0 were more likely to have a superficial wound separation (11.3% v 0%, p=.011) and less likely to experience Grade II complications (7.4% v 15.6%, p=.009). Few women had more than one unscheduled visit and rates were similar between the two groups (6.2% vs 6.8%, p=.810). On multivariable regression, younger women (aOR 1.03, 95%CI [1.001, 1.05]), those with lower BMI (aOR 1.07, 95%CI [1.13, 1.01]), and higher initial PACU pain scores (aOR 1.11, 95%CI [1.02-1.21]) were more likely to have an unanticipated healthcare encounter. Pain complaints were most often evaluated in the office compared to ED (41.1% vs 13.0%) while medical complications such as cardiac (15.6% vs 0%) and respiratory (6.5% vs 0%) were more likely to be evaluated in the ED. Higher Grade complications (II/III) were more likely to present to the ED (78.2% vs 27.1%, p< .0001).
Same-day discharge after prolapse surgery did not result in an increase in 30-day unanticipated healthcare encounters.