Highlights
- •The uptake of same-day discharge (SDD) for minimally invasive hysterectomies (MIH) was found to be increasing in a large healthcare system over years since the implementation of SDD initiative.
- •The uptake of SDD for MIH was associated with lower surgical complication rate.
- •The successful uptake of SDD across different specialty types in heterogeneous hospitals of UPMC proved the feasibility of applying SDD initiative across the country.
- •Compared with other specialties, the uptake of SDD was most prominent among urogynecologists.
Abstract
Objective
Hysterectomy is one of the most common surgical procedures. Same-day discharge (SDD)
is increasingly utilized for minimally invasive hysterectomies, but its uptake varies
across healthcare systems and surgical specialties. An evidence-based initiative was
developed to aid in the incorporation of SDD into the practice of minimally invasive
hysterectomy (MIH) in the UPMC Health System. The objective of this study was to identify
trends of SDD utilization across various gynecologic specialties at UPMC, as well
as evaluate the impact of SDD on length of stay (LOS) and complications after the
implementation of SDD initiative.
Study design
We retrospectively identified 5554 patients who underwent MIH between 2014 and 2017
and were eligible for SDD, as determined by physicians and authorized by patients’
insurance plans. Multivariable logistic regression models evaluated the trend of SDD
utilization among four specialty types (general gynecologists, urogynecologists, specialized
minimally invasive surgeons, and oncologists) and trends in complications. Multivariable
logistic and linear regression models were applied to compare complications and LOS
between patients with SDD vs. those with overnight admissions.
Results
SDD utilization increased from 28.55% to 74.99% during the study period. SDD significantly
increased over the study period for all specialty types, with urogynecologists having
the highest uptake from 3.9% in 2014 to 95.8% in 2017 (p<.01). After adjusting for
year, specialty types, MIH procedure type, and total case time, SDD utilization was
associated with shorter mean LOS (p<.01); such that mean LOS was 764.43 min (95% CI:
735.46–793.40) for SDD patients and 2041.84 min (95% CI: 2015.99–2067.70) for patients
with overnight admissions. SDD was also associated with 42% lower odds (95% CI: 0.37−0.93,
p=.02) of complications compared with patients with overnight admissions.
Conclusion
Same-day discharge uptake increased over years and was associated with lower odds
of complications and decreased length of stay. More studies are needed to explore
same-day discharge process to improve patient outcomes, patient satisfaction, and
value of care.
Abbreviations:
SDD (same day discharge), MIH (minimally invasive hysterectomy), TAH (total abdominal hysterectomy), LOS (length of stay)Keywords
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Article info
Publication history
Published online: February 23, 2021
Accepted:
February 20,
2021
Received in revised form:
February 16,
2021
Received:
November 30,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
