1645 Same Day Discharge after Minimally Invasive Gynecologic Surgery at an Urban, Safety-Net Hospital

Study Objective Same Day Discharge (SDD) after minimally invasive gynecologic surgery (MIGS) is an evidence-based safe alternative to inpatient hospital admission for appropriately selected patients. Many institutions have implemented SDD protocols after minimally invasive surgery with excellent outcomes. However, as there is clear disparity in access to minimally invasive surgery in safety net hospitals, we hypothesize a similar disparity in SDD. Our goals were 1) to implement a SDD pathway for patients undergoing MIGS at an urban, safety-net hospital and 2) to track outcomes following pathway implementation. Design A multidisciplinary SDD pathway was launched on December 3, 2018. A pilot study was conducted from December 1, 2017 until February 28, 2018. Setting N/A Patients or Participants Patients undergoing either total laparoscopic hysterectomy or laparoscopic myomectomy were eligible. Interventions N/A Measurements and Main Results Prior to SDD implementation, 46 patients were pre-screened; 40 (86.9%) were medically eligible for SDD. Accounting for social determinants of health, 34 (73.9%) would be eligible. 25 (54%) stated that they would feel comfortable going home on the same day, while 21 (46%) would not. The most common reasons for wanting to stay overnight were: anxiety (n=7), unsure of sufficient home care (n=4), fear of anesthetic reaction (n=5), fear of pain (n=3), and unsure of safety to go home (n=3). Specific materials were later developed to educate patients about the safety of SDD. Between SDD implementation and March 31st, 2019, 56 patients underwent MIGS, of whom 42 were eligible for SDD. 12 total patients were discharged home safely the same day without any adverse events or readmissions. Conclusion SDD is a safe alternative to inpatient admission without increasing adverse events or post-operative readmissions. We aim to use a screening tool and educational materials to identify eligible patients. We believe this will improve patient outcomes through shorter hospital stay and quicker return to baseline function.