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Readmission Rates after Same-Day Discharge Compared with Postoperative Day 1 Discharge after Benign Laparoscopic
David Sheyn1, Sherif El-Nashar1, Megan Billow1
1Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
Insights
Same-day discharge after laparoscopic hysterectomy shows similar readmission rates to postoperative day 1 discharge. This study found no significant difference in patient readmissions, supporting same-day discharge for low-risk patients.
Area of Science:
- Gynecology
- Surgical Outcomes
- Health Services Research
Background:
- Laparoscopic hysterectomy is a common gynecologic procedure.
- Optimizing patient recovery and discharge protocols is crucial for efficient healthcare delivery.
- Understanding readmission rates is key to evaluating surgical pathway effectiveness.
Purpose of the Study:
- To compare readmission rates between same-day (postoperative day 0) and postoperative day 1 discharges following laparoscopic hysterectomy.
- To identify factors associated with readmission after laparoscopic hysterectomy.
Main Methods:
- Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program database (2010-2015).
- Included women undergoing benign laparoscopic hysterectomy (total, supracervical, or laparoscopic-assisted vaginal) with or without adnexal surgery.
- Employed 1:2 propensity score matching to compare outcomes between same-day and postoperative day 1 discharge groups.
Main Results:
- The overall readmission rate was 1.8%.
- Readmission rates were 2.2% for same-day discharge versus 1.7% for postoperative day 1 discharge (p=0.10), with no statistically significant difference.
- Smoking, nonwhite race, and cystoscopy were independently associated with increased readmission risk.
Conclusions:
- There is no statistically significant difference in readmission rates for patients undergoing laparoscopic hysterectomy discharged on postoperative day 0 compared to postoperative day 1.
- These findings suggest that same-day discharge may be a safe option for carefully selected low-risk patients.
- Further research could explore specific patient selection criteria to optimize same-day discharge protocols.
Study Objective:
To determine if there is a difference in readmission rates after same-day discharge compared with postoperative day 1 discharges after laparoscopic hysterectomy.
Design:
A retrospective cohort study with 1:2 propensity score matching (Canadian Task Force classification II-2).
Setting:
American College of Surgeons National Surgical Quality Improvement Program database.
Patients:
Women undergoing benign laparoscopic total or supracervical hysterectomy or laparoscopic-assisted vaginal hysterectomy with or without adnexal surgery between the years 2010 to 2015.
Interventions:
Three thousand thirty-two low-risk women discharged on postoperative day 0 and 6064 women discharged on postoperative day 1 were included in the analysis.
Measurements And Main Results:
The overall readmission rate was 1.8%; after same-day discharge, the readmission rate was 2.2%, and after postoperative day 1 discharge the readmission rate was 1.7% (p = .10). After logistic regression analysis, smoking (adjusted odds ratio [aOR] = 2.06; 95% confidence interval [CI], 1.49-2.88), nonwhite race (aOR = 1.53; 95% CI, 1.1007-2.14), and cystoscopy (aOR = 2.05; 95% CI, 1.49-2.82) were associated with an increased risk of readmission.
Conclusion:
There was no statistically significant difference in readmission rates after laparoscopic hysterectomy between women discharged on the day of surgery or postoperative day 1.