Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin

Historical and Forecasted Changes in Utilization of Same-Day Discharge Following Minimally Invasive Hysterectomy

STUDY OBJECTIVES

To describe changes in length of stay and same-day discharges (SDD) following minimally invasive hysterectomy (MIH) over the last decade and forecast anticipated utilization over the subsequent decade.

DESIGN

Cross-sectional analysis SETTING: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

PATIENTS

All benign MIH excluding joint cases with concomitant non-gynecologic surgery in the 2011-2019 NSQIP datasets, identified by current procedural terminology code.

INTERVENTIONS

A descriptive analysis of changes in the estimated length of stay and utilization of SDD from 2011-2019. Multivariable negative binomial regression assessed for individual-level risk factors for prolonged hospital stay and autoregressive linear forecasting estimated the growth of SDD through 2029.

MEASUREMENTS AND MAIN RESULTS

239,220 MIH were identified. Over the 9-year period, SDD increased by 10.7% across all MIH. However, in 2019, SDD represented only 29.8% of total MIH discharges and utilization varied by surgical approach (laparoscopic hysterectomy: 35.4%; vaginal hysterectomy: 18.6%; laparoscopic-assisted vaginal hysterectomy: 19.6%) as well as a surgical indication of pelvic organ prolapse (32.7% without and 13.9% with prolapse). Multivariable models controlling for patient characteristics showed independent associations of route and indication for MIH and length of stay (adjusted relative rate 1.30, 95% CI 1.29,1.32 for vaginal hysterectomy and aRR 1.12, 95% CI 1.11, 1.14 for prolapse), however, these individual-level factors provided limited information explaining variation in the length of stay (model pseudo-R2 0.054). Forecasting models suggest that utilization of SDD will grow to 48.5% (95% CI 38.7-58.4) by the end of 2029.

CONCLUSION

While the estimated length of stay is decreasing among MIH over time, the utilization of SDD remained low in 2019, and was not explained by patient factors. If current trends hold, SDD utilization is not forecast to exceed 50% through 2029. Additional efforts focused on the provider and institution level are needed to encourage SDD as the standard of care for MIH.