SAME DAY DISCHARGE AFTER MINIMALLY INVASIVE HYSTERECTOMY IN THE COVID-19 PANDEMIC

ABSTRACT

Introduction: While same day discharge after minimally invasive hysterectomy (MIH) has demonstrated efficacy, patient's and provider's comfort and safety concerns have limited the universal transition to outpatient MIH. Beginning in March 2020, the COVID-19 pandemic led to an increased demand for hospital beds and limited the capacity for overnight admissions. Additionally, concerns over infection exposure increased patient and provider interest in limiting patient time in the hospital system. Together, these factors increased pressure for same day discharge in MIH cases. Objective: To quantify the impact of COVID-19 pandemic on same day discharges for MIH and evaluate the effect on postoperative outcomes and health care utilization. Methods: This was a retrospective cohort study of women who underwent MIH at a single institution between March 2018 and October 2021. Women over age 18 who underwent laparoscopic, vaginal, or robotic assisted hysterectomy by any gynecologic surgeon were included. Cases that converted to laparotomy or where a gynecologic surgeon was not listed as the primary surgeon were excluded. The primary objective measure was rate of same day hospital discharge. Secondary measures included length of stay and 30-day postoperative complications, readmissions, reoperations, and mortality. Continuous variables were summarized using medians (quantiles) and assessed with Wilcoxon rank tests;Categorical variables were presented using frequencies (percentages) and assessed with χ2 tests. All analyses were conducted using R version 4.1. Results: A total of 1608 women were included 896 in the pre-pandemic cohort and 712 in the post pandemic cohort. Demographics are summarized in Table 1. The pre-pandemic cohort was more likely to have an ASA class III or IV (P < 0.01) and more likely to have a diagnosis of diabetes (P < 0.01). Surgical characteristics are described in Table 1 and Figure 1. Breakdown of surgeon subspecialty was similar between groups, endoscopic procedures were more frequent in the post-pandemic cohort (p < 0.01), and the timing in the day of cases was not different between groups. Intraoperative complications were more frequent in the pre-pandemic cohort (2.8% vs. 1.0%, P < 0.01). The post-pandemic cohort was significantly more likely to discharge on postoperative day 0 (32% vs. 54%, P < 0.01). Rates of 30-day postoperative complications were not significantly different (16.4% vs. 15.4%, P = 0.60), and there were not significant differences in postoperative transfusion (0.6% vs 1.0%, P = 0.78), readmissions (3.5% vs. 2.5%, P = 0.28), reoperations (0.8% vs. 0.8%, P = 0.89), or mortality (1 vs. 0, P = 0.37). Thirty-day postoperative emergency department visits were more frequent in the post-pandemic cohort (0.1% vs. 1.3%, P < 0.01). Conclusions: The COVID-19 pandemic was associated with an increase in same day discharge without increase in 30-day postoperative complications, although there was a significant increase in postoperative emergency room visits. Our data suggests increased utilization of same day discharge is a safe strategy for management of capacity and hospital bed constraints caused by the COVID19 pandemic (Table Presented).