Dec. 21, 2019
Surgery rates for pelvic organ prolapse are expected to increase by 48% by 2050 due to the increasing age of the United States population. To meet those future needs, medical institutions are transitioning to more outpatient minimally invasive hysterectomies, which have been shown to be safe and cost-effective and are associated with high patient satisfaction. However, there's not much data on outpatient vaginal hysterectomy with pelvic floor reconstruction.
To determine the safety and feasibility of same-day discharge in patients undergoing vaginal hysterectomy with pelvic floor reconstruction, Johnny Yi, M.D., with Gynecologic Surgery at Mayo Clinic in Phoenix/Scottsdale, Arizona, and a team of researchers conducted a prospective cohort pilot study. Study results were published in the Journal of Minimally Invasive Gynecology in 2019.
"If patient safety can be maintained with same-day discharge, it could provide an impetus to move toward this practice," says Dr. Yi, noting that this shift has the potential for significant cost savings. "Other benefits may include lower risk of hospital-borne infections and optimized utilization of inpatient hospitalizations."
From February 2017 to March 2018, 55 women were identified preoperatively from Mayo Clinic's ambulatory female pelvic medicine and reconstructive surgery clinic. Patients who agreed to participate provided consent and chose either same-day discharge or an overnight hospitalization. All study participants were given a standardized protocol that included preoperative counseling and nutrition.
The control group consisted of 19 women who opted for planned overnight hospitalization. The intervention group consisted of 36 women who chose same-day discharge. The only statistically significant difference between the two groups was age: The average age for the control group was 61 years and the average age for the intervention group was 57 years.
Same-day discharge was accomplished in 23 of the 36 patients who opted for it.
"Those unplanned admissions were due to anesthetic effects, uncontrolled pain and anemia," Dr. Yi says. He also notes that there were no significant differences in the number of unplanned emergency department visits or unplanned office visits between the control and the intervention groups.
Patients with an anticipated same-day discharge were monitored in the recovery room for a minimum of four hours to ensure stability of vital signs and adequate pain control. After discharge, these patients were contacted within 24 to 48 hours to ensure safety and confirm that there were no signs of complications.
In similar studies, researchers found that outpatient hysterectomies performed with minimally invasive techniques had success rates of 79% to 85% with no increase in readmission or emergency room visits in patients who elected same-day discharge.
"These studies support our findings that same-day discharge does not result in a higher number of emergency department or outpatient office evaluations," says Dr. Yi. He does note, however, the study's limitations, including a small sample size and the fact that patients were not selected at random.
"Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible," Dr. Yi says. "This method may be appropriate for selected patients."
For more information
Liu L, et al. Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction: A pilot study. Journal of Minimally Invasive Gynecology. 2019;26:S214.