SpringerLink
Log in

Same-day Discharge Following Vaginal Hysterectomy and Native-tissue Apical Repair for Uterovaginal Prolapse: A Prospective Cohort Study

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The safety and feasibility of same-day discharge (SDD) has been consistently reported across the benign and gynecologic oncology literature. However, outcomes of SDD in the urogynecology population are sparse. The objectives of this study were to describe the success of SDD following vaginal hysterectomy and native-tissue colpopexy, and to compare the incidence of postoperative adverse events in patients discharged same-day versus postoperative day 1 (POD1). Further objectives were to compare pain, quality of recovery (QoR), and satisfaction between the groups.

Methods

This was a single-center, prospective cohort study of patients with planned SDD. A standardized ERAS protocol was utilized. The QoR-40 questionnaire was administered at baseline, POD2, and the 6-week postoperative visit. Pain scores were captured similarly, and a satisfaction survey was administered at 6 weeks. The primary outcome was composite adverse events defined as any postoperative adverse event and/or health care utilization, excluding telephone calls, and urinary tract infection.

Results

A total of 101 patients were enrolled in the study; the primary outcome was available for 99. SDD was achieved for 76 patients (77.0%); 23 patients stayed overnight (23.2%). The overall incidence of composite adverse events was 20.2% (95% CI, 13.5–29.2), and was not different between the groups (26.1% vs 18.4%, p = 0.42). Additionally, there were no differences in the QoR-40 or pain scores on POD2 and at 6 weeks. Patient satisfaction was high and similar between the groups.

Conclusions

Successful SDD was achieved in 77.0% of the patients. SDD following vaginal hysterectomy and native-tissue colpopexy appears to be safe, feasible, and associated with good QoR and a high degree of patient satisfaction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Doll KM, Dusetzina SB, Robinson W. Trends in inpatient and outpatient hysterectomy and oophorectomy rates among commercially insured women in the United States, 2000–2014. JAMA Surg. 2016;151(9):876–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–8.

    Article  PubMed  Google Scholar 

  3. Meyer LA, Lasala J, Iniesta MD, et al. Effect of an enhanced recovery after surgery program on opioid use and patient-reported outcomes. Obstet Gynecol. 2018;132(2):281–90.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Carey ET, Moulder JK. Perioperative management and implementation of enhanced recovery programs in gynecologic surgery for benign indications. Obstet Gynecol. 2018;132(1):137–46.

    Article  PubMed  Google Scholar 

  5. Harrison RF, Li Y, Guzman A, et al. Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs. Am J Obstet Gynecol. 2020;222(1):66.e61–9.

    Article  PubMed  Google Scholar 

  6. Zakaria MA, Levy BS. Outpatient vaginal hysterectomy: optimizing perioperative management for same-day discharge. Obstet Gynecol. 2012;120(6):1355–61.

    Article  PubMed  Google Scholar 

  7. Dedden SJ, Geomini P, Huirne JAF, Bongers MY. Vaginal and laparoscopic hysterectomy as an outpatient procedure: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2017;216:212–23.

    Article  PubMed  Google Scholar 

  8. Penner KR, Fleming ND, Barlavi L, Axtell AE, Lentz SE. Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies. Am J Obstet Gynecol. 2015;212(2):186e1–8.

    Article  PubMed  Google Scholar 

  9. Lloyd JC, Guzman-Negron J, Goldman HB. Feasibility of same day discharge after robotic assisted pelvic floor reconstruction. Can J Urol. 2018;25(3):9307–12.

    PubMed  Google Scholar 

  10. Hickman LC, Paraiso MFR, Goldman HB, Propst K, Ferrando CA. Same-day discharge after minimally invasive sacrocolpopexy is feasible, safe, and associated with high patient satisfaction. Female Pelvic Med Reconstr Surg. 2021;27(8):e614–9.

    Article  PubMed  Google Scholar 

  11. Pan C, Hale D, Heit M. Enhanced recovery protocol enhances postdischarge recovery after laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2021;27(11):667–71.

    Article  PubMed  Google Scholar 

  12. Liu L, Yi J, Cornella J, Butterfield R, Buras M, Wasson M. Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction: pilot study. J Minim Invasive Gynecol. 2020;27(2):498–503.e1.

    Article  PubMed  Google Scholar 

  13. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183(6):1365–73; discussion 1373–4.

    Article  CAS  PubMed  Google Scholar 

  14. Barber MD, Janz N, Kenton K, et al. Validation of the surgical pain scales in women undergoing pelvic reconstructive surgery. Female Pelvic Med Reconstr Surg. 2012;18(4):198–204.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Myles PS. Measuring quality of recovery in perioperative clinical trials. Curr Opin Anaesthesiol. 2018;31(4):396–401.

    Article  PubMed  Google Scholar 

  16. Fountain CR, Havrilesky LJ. Promoting same-day discharge for gynecologic oncology patients in minimally invasive hysterectomy. J Minim Invasive Gynecol. 2017;24(6):932–9.

    Article  PubMed  Google Scholar 

  17. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84(1):11–5.

    Article  CAS  PubMed  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Romanova AL, Carter-Brooks C, Ruppert KM, Zyczynski HM. 30-Day unanticipated healthcare encounters after prolapse surgery: impact of same day discharge. Am J Obstet Gynecol. 2020;222(5):482.e1–8.

    Article  PubMed  Google Scholar 

  20. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  21. Carter-Brooks CM, Du AL, Ruppert KM, Romanova AL, Zyczynski HM. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol. 2018;219(5):495.e1–10.

    Article  PubMed  Google Scholar 

  22. Bretschneider CE, Luchristt D, Kenton K, Sheyn D. Evaluating the association of same-day discharge following minimally invasive surgery for prolapse on 30-day postoperative adverse events. Int Urogynecol J. 2022;33(7):1849–56.

    Article  PubMed  Google Scholar 

  23. Robison EH, Smith PE, Pandya LK, Nekkanti S, Hundley AF, Hudson CO. Readmissions and perioperative outcomes for same-day versus next-day discharge after prolapse surgery. Int Urogynecol J. 2022;33(7):1897–905.

    Article  PubMed  Google Scholar 

  24. Scheib SA, Thomassee M, Kenner JL. Enhanced recovery after surgery in gynecology: a review of the literature. J Minim Invasive Gynecol. 2019;26(2):327–43.

    Article  PubMed  Google Scholar 

  25. Stone R, Carey E, Fader AN, et al. Enhanced recovery and surgical optimization protocol for minimally invasive gynecologic surgery: an AAGL White Paper. J Minim Invasive Gynecol. 2021;28(2):179–203.

    Article  PubMed  Google Scholar 

  26. Dieter AA, Moore KJ, Willis-Gray MG, Gutman RE, Iglesia CB, Carey ET. Length of stay and 30-day postoperative complications following minimally invasive apical prolapse repair. Urogynecology (Hagerstown). 2022;28(8):539–46.

    Google Scholar 

  27. Berger AA, Tan-Kim J, Menefee SA. Comparison of 30-day readmission after same-day compared with next-day discharge in minimally invasive pelvic organ prolapse surgery. Obstet Gynecol. 2020;135(6):1327–37.

    Article  CAS  PubMed  Google Scholar 

  28. O’Meara A, LaSala C, Rameseshan A, O’Sullivan DM, Tunitsky-Bitton E. Patient-initiated telephone calls before and after introduction of an enhanced recovery after surgery protocol for female pelvic reconstructive surgery. Urogynecology (Hagerstown). 2022;28(12):848–54.

    Article  Google Scholar 

  29. Evans S, Myers EM, Vilasagar S. Patient perceptions of same-day discharge after minimally invasive gynecologic and pelvic reconstructive surgery. Am J Obstet Gynecol. 2019;221(6):621.e1–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Katie A. Propst, MD, Beri M. Ridgeway, MD, Shannon L. Wallace, MD and Graham C. Chapman, MD for their support with patient recruitment. The authors would also like to extend their gratitude to Annette Graham, RN, BSN and Sheila Woodruff, RN, BSN for their support with participant recruitment.

Funding

This study was funded by the Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Author information

Authors and Affiliations

  1. Urogynecology, Advent Health, 960 Rinehart Road, Suite 2020, Lake Mary, FL, 32746, USA

    Viviana Casas-Puig

  2. Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    Marie Fidela R. Paraiso, Amy J. Park & Cecile A. Ferrando

Authors
  1. Viviana Casas-Puig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Fidela R. Paraiso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy J. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cecile A. Ferrando
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

V.C.-P.: protocol/project development, data collection/management, data analysis, manuscript writing/editing; M.F.R.P.: protocol/project development, data analysis, manuscript writing/editing; A.J.P.: protocol/project development, data analysis, manuscript writing/editing; C.A.F.: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Viviana Casas-Puig.

Ethics declarations

Conflicts of Interest

C.A.F. receives authorship royalties from UpToDate and Elsevier. A.J.P. and M.F.R.P. receive authorship royalties from UpToDate. The remaining author reports no conflicts of interest.

Additional information

Handling Editor: Jaromir Masata

Editor in Chief: Maria A. Bortolini

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Casas-Puig, V., Paraiso, M.F.R., Park, A.J. et al. Same-day Discharge Following Vaginal Hysterectomy and Native-tissue Apical Repair for Uterovaginal Prolapse: A Prospective Cohort Study. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05803-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00192-024-05803-6

Keywords

Search

Navigation