Effects of transversus abdominis plane block on discharge timing after minimally invasive hysterectomy: A retrospective cohort study

ABSTRACT

Objectives: The primary aim of this study was to compare time to discharge for gynecologic oncology patients who received a postoperative transversus abdominis plane (TAP) block following minimally invasive hysterectomy and those who did not. Methods: We performed an Institutional Review Board-approved, retrospective, single institution study of all gynecologic oncology patients who underwent robotic-assisted total laparoscopic hysterectomy from January 2019 to May 2020. We compared a cohort of patients who received an immediate postoperative TAP block to a cohort of patients who did not. Primary outcomes included time to discharge and date of discharge. Secondary outcomes included postoperative pain scores, opioid use in morphine milligram equivalents (MME), postoperative complications, urgent care/emergency visits and readmissions. Linear regression models were performed to adjust for covariates. Statistical analysis was performed using R Version 3.6.3. Results: Of the 171 patients who underwent minimally invasive hysterectomy by the gynecologic oncology service during the study period, 73 (42.7%) received a postoperative TAP block and 98 (57.3%) did not. The two cohorts had similar demographics and characteristics. Patients who received a TAP block had a shorter time to discharge (1454 min vs 1634 min, P = 0.001), without increasing time spent in the operating room. Patients who received a TAP block were more likely to discharge on postoperative day 1 (POD1) compared to patients who did not (81% vs 65%, P = 0.01). Patients who received a TAP block had less opioid use in the recovery room (10 MME vs 25 MME, P = 0.002), however, no difference was seen in opioid use after discharge from the recovery room (16 MME vs 23 MME, P = 0.25). Highest recovery room pain score was lower in the TAP block group (4 vs 7, P = 0.002), however, pain scores were similar on POD1 (5 vs 5, P = 0.86). No differences were seen in postoperative complications, urgent care/emergency visits, or readmissions. Linear regression adjusted for potential confounders showed a significant decrease in median time to discharge of 26.9% in the TAP block cohort (ratio of median 0.731, 95% CI 0.594 to 0.899). Conclusions: Utilization of a postoperative TAP block shortened time to discharge after minimally invasive hysterectomy in our gynecologic oncology patients. Addition of this perioperative intervention may help mitigate hospital resources, which is especially advantageous during the COVID-19 pandemic when resources are limited.