Same-Day Discharge is Safe, Feasible Following Vaginal Hysterectomy with Apical Suspension

Marlana M Ray,1 Jennifer Yeung,1 Jonathan Hoehn,2 Matthew Valenti,3 Kelsey E Lewis,1 Rachel N Pauls,1 Catrina C Crisp1 1Urogynecology Division, TriHealth, Cincinnati, OH, USA; 2Hatton Research Institute, TriHealth, Cincinnati, OH, USA; 3OB/GYN Department, University of Cincinnati, Cincinnati, OH, USACorrespondence: Marlana M Ray, TriHealth, Urogynecology Division, 3219 Clifton Ave, Medical Office Building Suite 100, Cincinnati, OH, 45220, USA, Email marlana_ray@trihealth.comPurpose: Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data, however, on same-day discharge outcomes for vaginal hysterectomy and pelvic reconstruction. This study aimed to compare 30 and 90-day surgical outcomes between same-day discharge versus overnight stay following vaginal hysterectomy and apical suspension.Patients and Methods: This retrospective study evaluated surgeries performed over two time periods. Overnight stay was standard between December 2018 and February 2020. Same-day discharge was standard from December 2020 to February 2022. All patients who underwent vaginal hysterectomy with apical suspension were included. The primary outcome was to determine if there was an increase in 30-day readmission rates. Secondary outcomes included emergency department visits and reoperations within 30 days, the previous variables at 90 days, and the rate for successful same-day discharge.Results: A total of 324 patients were analyzed over the 30 months: 149 (46%) in the overnight stay group and 175 (54%) in the same-day discharge group. At 30 days, no difference was found between groups for readmissions (2.7% vs 4.0%, p = 0.56), emergency department visits (14.8% vs 14.9%, p = 1.0), or reoperations (2.0% vs.1.7%, p = 1.0). At 90 days, outcomes were also similar. Same-day discharge as standard practice was successful in 80% of patients.Conclusion: In this retrospective two cohort study, the safety of same-day discharge following vaginal hysterectomy with apical suspension was demonstrated with no increased risk of 30 or 90-day readmissions, emergency visits, or reoperation rates. The majority (80%) of patients were discharged on the day of surgery, suggesting feasibility of this model.Keywords: female pelvic reconstructive surgery, urogynecology, vaginal prolapse repair, pelvic floor surgery