Risk Factors for Failed Same Day Discharge After Prolapse Surgery

Objectives: To evaluate the association between social and perioperative factors with failed same-day discharge (SDD) among women undergoing pelvic organ prolapse (POP) surgery. We hypothesize that increased perioperative morphine equivalents will be associated with failed same-day discharge after POP surgery.

Methods: This was a retrospective cohort study that included women > 18 years old undergoing surgery for POP as defined by current procedural terminology codes with planned same-day discharge from Jan 1, 2021 – Oct 1, 2023. This study was performed at an academic tertiary care center after approved by the institutional review board. Demographic and perioperative data for patients undergoing POP surgery were extracted from the electronic medical record. Failed SDD was defined as hospital discharge after the date of surgery. Multivariable logistic regression models were fit to compute the adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk factors and their association with failed SDD. Co-variate selection was based on a priori clinical knowledge and model-driven using the least absolute shrinkage and selection operator (LASSO) with cross-validation method.

Results: 728 patients met inclusion criteria with median age of 68 years. They mostly self-identified as Caucasian race and 21.2% self-identified as Hispanic or Latino/a. 48.5% had hysterectomies and 84% had apical suspensions during their procedure. Failed SDD occurred in 303 (41.6%) patients. Patient characteristics and perioperative factors associated with the odds of failed SDD are in the Table. In the adjusted model, associations of Caucasian race and Area Deprivation index with failed SDD were no longer significant. Variables remaining were significantly associated with failed SDD after adjusting were total morphine equivalents [OR 1.04 (1.03-1.05, p< 0.001); higher age [OR 1.02 (1.01-1.04), p=0.011]; operative time [OR 1.01 (1.01-1.01), p< 0.001]; and receiving a sedating medication [OR 2.16 (1.37-3.45), p=0.001].

Conclusions: Among patients undergoing POP surgery, failed SDD was associated with demographic and perioperative factors including age, total morphine equivalents, and administration of sedating medications on the day of surgery. Adherence to advanced recovery pathways with minimization of sedating medications may promote SDD in this patient population.

Table Legend:
*Reference value = “not present/no” unless otherwise stated
^Model adjusted for total perioperative morphine equivalents, age at surgery, body mass index (BMI), race, ethnicity, marital status, area deprivation index (ADI), operative time, and sedating medication use. ADI is an ordinally ranked score that measures socio-economic disadvantage (higher ADI represents greater disadvantage).
**Sedating medications include: Midazolam (Versed), Phenergan, Scopolamine patch, Gabapentin