Same day discharge is safe and feasible following total vaginal hysterectomy and pelvic reconstruction

Historically, planning an overnight stay following total vaginal hysterectomy (TVH) with vaginal reconstruction has been standard practice. Recent research involving minimally invasive hysterectomy and robotic sacrocolpopexy has demonstrated safety and feasibility utilizing same day discharge (SDD). There is limited data, however, on same day discharge outcomes for TVH with vaginal reconstruction. This retrospective study evaluated surgeries performed by the Urogynecology Division at a community-based academic institution over two time periods. Overnight stay (OS) was the standard practice between December 2018 and February 2020, while same day discharge (SDD) was the standard practice from December 2020 to February 2022. All subjects who underwent TVH with vaginal reconstruction in these time periods were included. Primary outcomes were 30-day readmission rates, ED visits, and re-operations. Secondary outcomes analyzed the same variables at 90 days and determined the rate for successful same day discharge. Statistical analysis was performed with Mann-Whitney U Test for continuous variables and Fisher’s Exact Test for categorical variables. A total of 340 subjects were analyzed: 155 (46%) in the overnight stay period and 185 (54%) in the same day discharge period. There were no differences in demographic data including age, race, ethnicity, and BMI. When evaluating 30-day readmission rates, there was no difference between overnight stay as standard practice verses same day discharge as standard practice (2.6% vs 3.8% respectively; p=0.76). ED visits within 30 days after surgery were evaluated and no difference between groups was found (OS 14.2% vs SDD 14.1%, p=1.0). Similarly, reoperations were analyzed with no difference found (OS 1.9% vs SDD 1.6%, p=1.0). At 90 days, readmissions (OS 3.9% vs SDD 4.3%, p=1.0), ED visits (OS 16.1% vs SDD 15.1%, p=0.88), and re-operations (OS 1.9% vs SDD 1.6%, p=1.0) were also not significantly different. Rates of postoperative urinary retention (OS 72.3% vs SDD 74.1%, p=0.71) and high-volume blood loss (EBL >200ml) (OS 26.5% vs SDD 26.5%, p=1.0) were similar. For the period of same day discharge as standard practice, 80% of the subjects were successfully discharged the same day. In this retrospective two cohort study, patients undergoing TVH with vaginal reconstructive surgery had similar outcomes with SDD as compared to an overnight stay. With no increased risk of 30 or 90-day readmissions, ED visits, or re-operation rates, safety of same day discharge was demonstrated. Furthermore, the vast majority (80%) of subjects were able to be discharged on the day of surgery, suggesting that patients are willing to accept this model. We believe that surgeons may feel reassured about planning for SDD following major pelvic reconstructive surgery.