Impact of Covid on National Trends in Same Day Discharge After Prolapse Surgery

Objectives: Ample evidence demonstrates that same-day discharge (SDD) after gynecologic surgery is safe and associated with high patient satisfaction. Resource constraints of the COVID-19 pandemic required healthcare providers to consider earlier hospital discharge following elective prolapse surgery. While numerous single institution analyses have described increases in SDD, no studies of national trends have been published. Our primary objective is to describe national trends in SDD after surgery for pelvic organ prolapse (POP) before and during the COVID-19 pandemic.

Methods: All patients who underwent a POP surgery, including apical suspension or isolated compartment repair, from 2016 to 2022 were identified using CPT coding in the National Surgical Quality Improvement Program database. Individuals with an oncologic indication or concomitant non-gynecologic procedure were excluded. We extracted data on patient demographics and health status to assess underlying characteristics that could confound SDD eligibility. An interrupted time series analysis using the COVID-19 pandemic lockdown (April 2020) as a transition point estimated the impact of the pandemic on SDD utilization following POP surgery using segmented linear regression.

Results: During the study period, 90,379 patients underwent POP surgery. The average age of patients was 60 years old (SD, 13), with an average body mass index of 28 kg/m2 (SD, 6). A small proportion (2%) of patients had a documented major medical comorbidity, and 73% were American Association of Anesthesiologists (ASA) class 1 or 2. The pandemic was associated with a one-time shift in SDD utilization of 4.8% (95% CI, 0.2, 7.9) and a change in the growth of SDD from 0.8% (95% CI, 0.5, 1.0) to 1.6% (95% CI, 1.2, 2.2) per quarter. (Figure 1). We observed small shifts in the type of POP repair performed over the entire time period (Table 1), with a 0.5% (95% CI, 0.4, 0.6) increase per quarter in performance of an apical suspension and a 0.2% decrease (95% CI -0.2, -0.1) in performance of an anterior and/or posterior colporrhaphy. However, the pandemic was not associated with changes in these underlying procedural trends.

Conclusions: Despite the popular assumption that the COVID-19 pandemic dramatically impacted SDD rates, this study finds the change in SDD rate after POP surgery was quite modest. While patient characteristics remained stable over the six-year period, modest shifts were noted in the type of POP surgery performed. However, these shifts were not associated with SDD utilization. Further investigation is warranted to elucidate the factors associated with SDD including barriers to utilization, as this significantly influences patient care and healthcare resource utilization. 

Figure 1 Legend: Dots are observed rates of SDD. Solid line is the model estimated trend, with dashed line 95% CI.