Variability in Postoperative Voiding Practices Across Gynecologic Services: Opportunities for Standardized Protocols in Outpatient Care

Delayed trial of void (TOV) after outpatient gynecologic surgery can prolong recovery and delay discharge. Despite its importance, no standardized voiding protocol exists, leading to inconsistent practices across general gynecology (GYNE), urogynecology (UROGYNE), and gynecologic oncology (GYNEONC) services. This project characterized variation in postoperative TOV management and identified factors associated with time to first void to inform future standardized, risk-stratified protocol development.

A single-center retrospective review of outpatient gynecologic surgery was conducted using quality improvement methodology.

Patients undergoing outpatient gynecologic procedures at a tertiary hospital between August 2023 and August 2024 were included (n = 185). Descriptive statistics compared patient characteristics, operative factors, and postoperative bladder management practices. Multivariable linear regression evaluated time to first void, adjusting for age and body mass index (BMI). Secondary outcomes included post-anesthesia care unit (PACU) length of stay, retrofill practices, and physician-directed voiding criteria. Exploratory sensitivity analyses using nested linear models evaluated the influence of operative duration, intraoperative narcotic administration, and retrofill volumes.

Postoperative bladder management varied across services, including retrofill practices, voiding criteria, post-void residual thresholds, and the number of permitted voiding attempts. After adjustment for age and BMI, time to first void attempt was 44.7 minutes longer in GYNE patients and 57.8 minutes longer in GYNEONC patients than in UROGYNE patients. Further adjustment for operative duration and intraoperative narcotic administration attenuated between-service differences, suggesting that operative complexity accounted for part, but not all, of the observed variation; most variance in time to first void remained unexplained. PACU length of stay was similarly prolonged across all services (GYNE 306.7 ± 140.6 minutes, GYNEONC 314.8 ± 136.1 minutes, UROGYNE 303.9 ± 109.5 minutes) despite differences in TOV timing.

Substantial variation in postoperative TOV management existed across outpatient gynecologic surgical services. Although differences in time to first void were partially explained by operative duration and intraoperative narcotic administration, meaningful variability persisted in retrofill practices, void timing, and physician-directed voiding criteria. These findings support prospective evaluation of a risk-stratified, evidence-informed TOV protocol using patient-centered outcomes.