Department of Urology, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Neurourol Urodyn. 2021 Sep;40(7):1754-1760. doi: 10.1002/nau.24739. Epub 2021 Jul 5.
Enhanced recovery after surgery protocols and increased attention to value-based care have led to the reconsideration of routine postoperative admission in female pelvic medicine and reconstructive surgery (FPMRS) cases. We aimed to assess trends in same-day discharge (SDD) and associated readmissions and emergency room visits in a single-surgeon 10-year experience.
The electronic medical record was queried for 30-day outcomes (readmission and emergency department visits with associated indications) for all cases performed between June 2010 and August 2020 by a single FPMRS surgeon. Non-FPMRS specialty cases were excluded. Patient characteristics and 30-day outcomes were compared based on SDD status for the overall cohort as well as the subset of cases traditionally involving an overnight stay (i.e., robotic transabdominal, apical prolapse repair).
1793 surgeries were identified and analyzed, including 357 apical prolapse repairs, 370 slings, 392 neuromodulation and 114 complex mesh excisions. The majority (79.1%) had SDD. For admitted patients, mean length of stay was 1.5 (1.3) days. Among cases traditionally involving overnight stay, rates of SDD were significantly higher in 2020 than 2010 (84% vs. 32%, p < 0.001), and increased over time. Overall rates of 30-day readmission and ED visits were low (1.9% and 2.6%, respectively) and did not differ based on SDD status (p = 0.76). Readmissions occurred at mean 11.6 (7.0) days, most commonly for urinary tract infection (13/34).
SDD is not associated with increased 30-day readmission or ED visits across a wide breadth of FPMRS cases. SDD is safe and feasible in the majority of FPMRS cases.
手术后恢复方案的加强和对基于价值的护理的重视，促使人们重新考虑女性盆底医学和重建外科（FPMRS）病例的常规术后住院治疗。我们旨在评估一位 FPMRS 外科医生 10 年经验中单天出院（SDD）和相关再入院和急诊就诊的趋势。
通过查询 2010 年 6 月至 2020 年 8 月期间由一位 FPMRS 外科医生进行的所有病例的 30 天结局（再入院和急诊就诊的相关指征），来检索电子病历。排除非 FPMRS 专科病例。根据 SDD 状态，比较了所有病例以及传统上需要过夜住院的病例亚组（即机器人经腹、顶端脱垂修复）的患者特征和 30 天结局。
共确定并分析了 1793 例手术，包括 357 例顶端脱垂修复术、370 例吊带术、392 例神经调节术和 114 例复杂网片切除术。大多数（79.1%）患者实现了 SDD。对于住院患者，平均住院时间为 1.5（1.3）天。在传统上需要过夜住院的病例中，2020 年 SDD 率明显高于 2010 年（84%比 32%，p < 0.001），且呈上升趋势。总的 30 天再入院和急诊就诊率较低（分别为 1.9%和 2.6%），且与 SDD 状态无关（p = 0.76）。再入院的中位时间为 11.6（7.0）天，最常见的原因是尿路感染（34 例中有 13 例）。
在广泛的 FPMRS 病例中，SDD 与 30 天再入院或急诊就诊的增加无关。在大多数 FPMRS 病例中，SDD 是安全且可行的。
