Minimally Invasive Sacrocolpopexy-Which Patients Are Likely to Stay Overnight?

Minimally invasive sacrocolpopexy (MISC) is a highly successful surgical procedure for pelvic organ prolapse. In today's health care setting, cost is an important issue with savings from same-day discharge (SDD) versus observation/admission (O/A).

The purpose of this study was to determine risk factors for O/A versus SDD in patients undergoing MISC.

A retrospective cohort study was performed from 2018 to 2023 on patients undergoing MISC within the Cleveland Clinic system. The primary outcome was to determine risk factors for O/A with a secondary analysis for postoperative differences. Univariate analysis assessed the association between the patients' characteristics and discharge time. The χ2 or Fisher exact test was used for categorical factors, and the Wilcoxon rank-sum test was applied for continuous factors. Multivariate logistic regression with backward elimination was conducted to determine the independent factors for discharge. A P value <0.05 was considered statistically significant.

Out of 798 patients, 537 had SDD and 261 had O/A after MISC. Multivariable logistic regression revealed the following as independent factors for O/A: race as "other," late surgical start time, increased operative time, higher first and last pain score, and higher American Society of Anesthesiologists classification. Postoperatively, O/A was associated with higher rates of unplanned office and emergency department visits, more office messages, and fewer catheters at discharge.

In this study, several factors were associated with O/A versus SDD with MISC. Awareness of these factors may help with counseling patients, setting expectations, and arranging surgical schedules to maximize SDD and decrease costs. Further studies are needed to quantify costs and patient satisfaction.