Outcomes of Same Day Discharge vs Admission Post Transvaginal Hysterectomies

Objectives: To identify whether patients with same day discharge after a transvaginal hysterectomy had better, worse, or the same outcomes as patients admitted for surgical observation post-op. Secondary outcomes explored included causes associated with surgical and post-op complications, emergency department visits within 30 days after surgery, and opioid prescription refills.

Methods: This was a retrospective cohort analysis of women who underwent a transvaginal hysterectomy (TVH). Data collected included demographics, indications, comorbidities, BMI, blood loss, complications, and discharge dates using REDCap. Indications for hysterectomy were grouped into abnormal uterine bleeding (AUB) vs pelvic organ prolapse (POP). The women were separated into same day discharge (SDD) and non same day discharge (non-SDD) groups. Comparisons based on readmission, comorbidities, indications, and complications were then analyzed.

Results: The patient cohort consisted of 211 patients, however, 4 patients did not meet the inclusion criteria, therefore 207 patients were included in the study. 78 of those patients were discharged on the same day while 129 were admitted for surgical observation. Compared to the SDD cohort, the non-SDD cohort had a higher percentage of patients with comorbidities (83% vs 14%, p < 0.001). Patients with SDD were less likely to be readmitted in the immediate post-op period compared to the non-SDD group (OR of 0.86 with a 95% CI: 0.018 - 0.406; p = 0.0019). Furthermore, more patients from the AUB cohort, undergoing the TVH, had complications compared to the POP cohort (20 vs 11 patients). Lastly, none of the patients from the SDD cohort requested opioid prescription refills or had emergency visits within 30 days after the surgery.

Conclusions: We believe that same day discharge can be a safe and cost-effective option for younger and healthier patients after a transvaginal hysterectomy. Patients who were discharged on the same day were less likely to be readmitted in the post-op period, had less emergency department visits, and needed less opioid prescription refills. However, patient selection criteria for same day discharge needs to be assessed carefully as older patients and patients with pre-existing comorbidities tend to have increased post-op complications. Lastly, consideration should be taken on indications for surgery as more women in our cohort who underwent the TVH for AUB had post-op complications when compared to those in the POP cohort.