URPS Same-Day Surgery in an Underserved and Non-English Speaking Population

Objectives: Same-day discharge (SDD) for minimally invasive gynecologic and urogynecologic surgery has been shown to be feasible and safe in predominantly English-speaking populations. These studies have not specifically included outcomes in more diverse patient populations, namely underserved, minority, and primarily non-English-speaking demographics. While SDD protocols were initiated in gynecology at our institution in 2018, these efforts were expanded to urogynecology in 2019. This study aims to investigate the outcomes and feasibility of SDD for minimally-invasive urogynecologic surgery in a safety net hospital which predominantly cares for underserved and non-English speaking population.

Methods: A retrospective chart review of all urogynecology procedures at a single tertiary safety net hospital between January 1, 2019 and June 30, 2023 was performed. Inclusion criteria were patients over 18 years of age who underwent urogynecologic surgery that included either a hysterectomy and/or multi-compartment prolapse repairs who would have historically had a postoperative admission. Single-compartment repairs and isolated incontinence procedures were excluded, as were planned admissions. Patient demographics were recorded. Outcomes that were evaluated included unplanned admission, visit to the emergency department (ED) within 30 days of surgery, void trial results, prolonged catheterization, and surgical complications.

Results: 118 charts met inclusion criteria for review. 20.3% of patients were White, 79.7% were non-white, the majority of which identified as Hispanic or African/Afro-Carribean (Table 1). The cohort consisted of 40.7% English speakers. The primary languages of the 59.3% of non-English speakers included Spanish (37.3%), Cape Verdean Creole (5.1%), Haitian Creole and Arabic (4.2% each), and Other (8.5%). The median age of patients was 61 (SD ±11.2) and BMI of 29.5 (SD ±5.3). All patients had a preoperative visit where counseling specific to SDD was reviewed per protocol at our institution. The majority of cases had multiple procedures performed including vaginal hysterectomies (63.6%), anterior-posterior colporrhaphy (91.5%), perineal repair (83.9%), and uterosacral ligament suspension (52.5%). Of the 118, eighteen had unplanned post-operative admissions, primarily due to incomplete pain control (76.5%). 39.8% of patients were discharged with a catheter for a failed void trial, three failed an outpatient void trial necessitating short-term self-catheterization. Ten patients presented to the ED within 30 days, either for pain or constipation. One patient required readmission and retreatment for a surgical wound complication.

Conclusions: SDD appears to be both safe and feasible in a safety net, majority non-English speaking population. ED visits, readmissions, and complications were low. Special consideration should be given to providing adequate interpreter services and preoperative preparation. Additionally, specific attention to preoperative counseling about pain management and bowel management can be helpful in reducing emergency visits.