Safety and Feasibility of Rapid Transition to Universal Same-Day Discharge After Minimally Invasive Hysterectomy: A...

The primary objective was to examine the success of rapid implementation of universal same-day discharge (SDD) by examining SDD rates after minimally invasive hysterectomy. The secondary objectives were to explore readmission rates after SDD and the impact of geographic and socio-demographic factors on successful SDD. The relationship between unplanned admission rates and neighborhood-level deprivation, as defined by the Area Deprivation Index, was also examined.

Retrospective, before-and-after chart review.

Two high-volume academic and academic-affiliated tertiary care centers.

Patients were selected from two 11-month periods: September 2018 to July 2019 (pre-COVID) and May 2020 to March 2021 (COVID).

Laparoscopic or robotic assisted hysterectomy with same-day discharge.

A total of 320 patients met the inclusion criteria: 107 pre-COVID and 213 COVID. SDD rate increased from 1.9% (2/107) pre-COVID to 92% (196/213) during COVID (p <.001). There was no difference in 30-day readmission rates or re-operation rates after rapid implementation of SDD (0% vs 0%). Within the COVID-19 cohort, there was no significant difference between patients with successful SDD and those admitted with respect to body mass index, American Society of Anesthesiologists class 2 or greater, length of surgery, procedure completion time, estimated blood loss, uterine specimen weight, non-private insurance, neighborhood deprivation level, or time or distance traveled to the hospital.

Rapid transition to universal SDD in response to the COVID-19 pandemic was safe and feasible in patients undergoing benign minimally invasive hysterectomy. During COVID, universal SDD was implemented successfully in patients without an increase in reoperation or readmission rates. Neighborhood deprivation level is not associated with an increase in unplanned admission rates.