Increased same-day discharge for minimally invasive hysterectomy during COVID-19

Key takeaways:

• Same-day discharge after minimally invasive hysterectomy significantly increased during the COVID-19 pandemic.
• The rise did not cause a significant increase in hospital readmission rates.

During the COVID-19 pandemic, same-day discharges following minimally invasive hysterectomy for benign indications increased without also increasing postoperative hospital readmission, researchers reported.

“We aimed to determine whether the COVID-19 pandemic was associated with increased likelihood of same-day discharge among patients undergoing elective minimally invasive hysterectomy for benign indications and discharged within postoperative day 1,” Caroline Fryar, MD, MPH, third-year resident in the department of obstetrics and gynecology at the Brody School of Medicine at East Carolina University, and colleagues wrote. “Our secondary aim was to determine whether the pandemic was associated with postoperative readmission rates after same-day discharge.”

Fryar and colleagues conducted a retrospective cohort study, published in the American Journal of Obstetrics and Gynecology, with data from 63,140 cases of women who underwent benign elective minimally invasive hysterectomy from 2016 to 2021. Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program database, researchers identified cases and assessed day of discharge following surgery before and after the COVID-19 pandemic.

The primary outcome was same-day discharge, and the secondary outcome was any 30-day hospital readmission after same-day discharge.

Thirty-one percent of hysterectomies were performed during COVID-19 with 40% resulting in same-day discharge, and 1.7% of discharges resulting in hospital readmission.

During the pandemic, same-day discharge rates for women discharged within day 1 increased from 32% to 58% (P < .001), and hospital readmission rates after same-day discharge increased from 1.6% to 1.9%, which was not statistically significant.

Same-day discharge odds increased immediately following COVID-19 onset (OR = 1.42; 95% CI, 1.33-1.53). Researchers observed a trend of same-day discharge rates that increased incrementally from pre-pandemic (OR = 1.04; 95% CI, 1.04-1.05; P < .001) to during the pandemic (OR = 1.15; 95% CI, 1.13-1.17; P < .001). However, hospital readmissions after same-day discharge were not impacted by COVID-19 onset.

“It is possible gynecologic surgeons were compelled to change their perspective on same-day discharge given the financial losses incurred from less work during the pandemic,” the researchers wrote. “This observation demonstrates the effect of an environmental factor’s disruption of surgical practice patterns and suggests a broader reassessment of how hysterectomy is reimbursed to drive higher value care practices.”