Same-Day Discharge after Vaginal Hysterectomy with Pelvic Floor Reconstruction: Pilot Study

Study Objective: To determine the safety and feasibility of same-day discharge (SDD) in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. Design: Prospective cohort pilot study. Setting: Single academic medical center. Patients: Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. Interventions: SDD or overnight hospitalization after surgery. Measurements and Main Results: A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women who were planned for overnight hospitalization. The intervention group had 36 women who were planned for SDD. In the intervention group 63.9% of patients (n = .23) were successfully discharged home and 36.1% (n = .13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness, n = .9, 69%), uncontrolled pain (n = .1, 7.7%), fever (n = .1, 7.7%), anemia (n = .2, 15.4%), with return to operating room for hematoma evacuation (n = .1, 7.7%). A voiding trial was passed on the first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (p = .011). There were no significant differences in the number of emergency department visits (p = .677) or unplanned office visits (p = .193) between the control and intervention groups. Conclusion: SDD after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same day did not require a higher volume of emergency department or office evaluations.