Evaluating the association of same-day discharge following minimally invasive surgery for prolapse on 30-day postoperative adverse events.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the association of same-day discharge and outcomes following minimally invasive surgery for pelvic organ prolapse (POP). METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we identified women undergoing POP surgery between 2014 and 2018 who were discharged on the day of surgery (same-day) or on postoperative day 1 (POD1). Patient and procedural characteristics, and 30-day outcomes including readmission, reoperation, and postoperative complications, were abstracted. Multivariate logistic regression was used to determine the association of day of discharge and complications, readmission, and reoperation while controlling for potential confounders. RESULTS: A total of 33,614 patients met the inclusion criteria: 20% patients were discharged on the same day, whereas 80% were discharged POD1. The mean ± SD age for the cohort was 61 ± 12 years, with a median (IQR) body mass index (BMI) of 28 (25-32) kg/m2. The overall postoperative complication rate was 5.4%. Patients discharged on the same day had lower rates of complications (4.8% vs 5.5%, p = 0.02) and lower rates of readmission (1.6% vs 2.0%, p = 0.03) compared with those discharged on POD1. No difference in reoperation rates (0.9% vs 1.1%, p = 0.31) were noted between groups. In multivariate logistic regression models controlling for age, race, BMI, ASA class, smoking, procedure type, and operative time, day of discharge was not associated with increased odds of postoperative complications (same-day discharge: aOR 1.00, 95% CI 0.88-1.14), reoperation (aOR 0.83, 95%CI 0.61-1.12), or readmission (aOR 0.93, 95%CI 0.74-1.16). CONCLUSIONS: Same-day discharge did not impact the rate of adverse events after minimally invasive prolapse surgery.

Trends in Performance of Anti-Incontinence Treatment at the Time of Pelvic Organ Prolapse Repair From 2011 to 2019.

IMPORTANCE: There are no publications on national trends in performance of concomitant stress urinary incontinence (SUI) treatment with pelvic organ prolapse surgery over the past decade. OBJECTIVES: The objective of this study was to describe trends in the performance and type of concomitant SUI treatment from 2011 to 2019. STUDY DESIGN: Surgical procedures for pelvic organ prolapse and coding for prolapse repair were identified from the American College of Surgeons National Surgical Quality Improvement Program database. An autoregressive interrupted time series model estimated temporal trends in concomitant SUI treatment associated with 3 consequential events: U.S. Food and Drug Administration's (FDA) requirement for postmarketing studies from mesh manufacturers (January 2012), publication of the Outcomes following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial (June 2012), and the FDA's reclassification of vaginal mesh as a high-risk device (January 2016). RESULTS: There were 43,370 cases identified. The rate of concomitant SUI treatment decreased from 46.1% to 35.7% across the analysis period. No significant trend before postmarketing studies (-0.2%; 95% confidence interval [CI], -0.8 to 1.1) was observed. After postmarketing studies, there was a downward deflection of -2.0% per quarter (95% CI, -3.6 to -0.4). After OPUS, we observed a flattening of the trend to -0.2% (95% CI, -0.8 to 0.4) that persisted after FDA reclassification. Sling procedures remained predominant (96.2% of SUI procedures) and performance of urethropexy decreased across the analysis period (-0.1%; 95% CI, -0.08 to -0.2). CONCLUSIONS: After the FDA's order for postmarketing studies, rates of concomitant SUI treatment significantly decreased. Rates stabilized after the OPUS trial at around 35% and did not subsequently change. Rates of nonmesh concomitant SUI treatment decreased during the analysis period.