Minimally Invasive Sacrocolpopexy - Which Patients Are Likely to Stay Overnight?

Objectives: Minimally invasive sacrocolpopexy is a highly successful surgery for the treatment of pelvic organ prolapse. In today’s healthcare setting, cost is an important issue with savings noted with ambulatory surgery versus observation. However, this must be balanced with patient care and satisfaction. To better understand the factors that result in prolonged stay, this study looks at the risk factors for overnight admission.

Methods: A retrospective cohort study was performed comparing risk factors between post-operative admission and same-day discharge after minimally invasive sacrocolpopexy across a single healthcare system. Univariate analysis was performed to assess the association between the patients’ characteristic factors and discharge time, in which Chi-square test or Fisher’s exact test was using for categorical factors, while Wilcoxon’s rank-sum test was applied for continuous factors. Multivariate logistic regression model with backward elimination method was conducted to determine the independent factors for the discharge. A p-value of less than 0.05 was considered statistically significant.

Results: 143 patients were discharged on the same day of surgery and 97 patients were kept overnight after laparoscopic or robotic sacrocolpopexy in 2023. Patients with longer operative time (OR=3.65, p < .0001), those who did not undergo ERAS (Enhanced Recovery After Surgery) protocol (OR=4.66, p 0.0243), and patients with a past medical history of anxiety (OR=2.77, p 0.0075) were more likely to stay overnight. Patients with later case start times were also more likely to stay overnight, with the highest likelihood of staying if the case started after 3pm (OR=10.35, p 0.0004). Higher blood loss, those undergoing a concurrent hysterectomy with removal of the cervix, and surgeries requiring an intraoperative consult were also more likely to stay the night. A shorter distance from home to the hospital was also a risk factor for admission (OR=2.1, p 0.0173).

Conclusions: Since introduction of the ERAS protocol, a significant number of patients still stay the night after minimally invasive sacrocolpopexy (40.42% of patients in our study). This study has identified possible risk factors for admission, so that we can best counsel our patients and make perioperative planning to balance costs and patient safety/satisfaction.