Contemporary length of stay and resource utilization when using a fast-track regimen for mid-urethral sling surgery

To evaluate the length of stay and need for postoperative laboratory monitoring in a fast-track regimen, as despite the excellent safety profile of the tensionless synthetic midurethral sling, many advocate routine in-house postoperative monitoring of both vital signs and laboratory values.

A retrospective chart review was performed of all patients presenting for isolated, midurethral sling surgery by a single surgeon from February 2005 to July 2007. Patients followed a perioperative care pathway. Hospital charts were reviewed for the following data: date and time of admission to recovery, date and time of discharge, age, anesthetic, whether postoperative laboratory work was ordered, transfusion of blood, emergency room visits within 30 days, readmissions within 7 and 30 days, and whether the patient was discharged with a catheter.

A total of 112 procedures were performed. Twenty-six cases were excluded because of either concomitant surgical procedures (22) or incomplete data (4), resulting in 86 patients. The median age was 52 years (range 34-89). The mean length of stay was 2.42 hours and the median was 2.15 hours. No postoperative laboratory tests were ordered and no transfusions were required. One patient presented to the emergency room within 30 days and was admitted for chest pain. Of 86 patients, 79 (92%) were discharged home without a catheter.

When following the fast-track regimen, the tensionless midurethral sling can be performed safely in the outpatient setting without postoperative laboratory work and with a median recovery to discharge time of < 3 hours.