Norton JC, Khalil MI, Bhandari NR et al: Early postoperative complications and factors associated with early vs late discharge of patients undergoing colporrhaphy for pelvic organ prolapse: a national report. Urol Pract 2021; 8: 431.

Pelvic organ prolapse (POP) remains a highly prevalent condition in the United States, with up to two-thirds of parous women exhibiting some degree of pelvic floor muscle weakening upon examination and roughly 10–12% becoming symptomatic.^1–3 Primarily, POP is treated nonsurgically with pelvic floor muscle exercises and pessaries, but with the lifetime risk of POP surgery estimated to be 10–13%, a large number of patients will need surgical intervention such as colporrhaphy.¹ Within the field of Female Pelvic Medicine and Reconstructive Surgery (FPMRS), colporrhaphy is commonly performed on an outpatient basis, where one study found that inpatient procedures have decreased by 29% in the decade prior to 2011.⁴

Promoting outpatient procedures may be more favorable because of reduced rates of hospital admissions and associated health care costs. However, there is a paucity of research describing outcomes and potential adverse effects associated with the length of hospitalization in colporrhaphy procedures. We used data from the National Surgical Quality Improvement Program database to examine factors associated with patients who were more likely to be discharged within 24 hours (early discharge group [EDG]) vs patients who required longer than 24 hours (late discharge group [LDG]) following colporrhaphy cases via a vaginal approach between 2005 and 2016.⁵

Figure. Multivariate analysis of factors associated with early discharge after colporrhaphy (vs late discharge). WBC, white blood cell.

Using CPT codes, we identified 11,652 female patients who had undergone colporrhaphy (3,728 EDG and 7,924 LDG).⁵ We found that patients greater than 75 years of age (16.8% vs 10.9%, p <0.001), patients with higher body mass indexes (BMIs) (29 kg/m² vs 28.3 kg/m², p <0.001), higher American Society of Anesthesiologists® (ASA®) scores (class ≥III: 26.8% vs 20.7%, p <0.001), and current smokers (10% vs 8.6%, p=0.02) were more likely to be in the LDG than the EDG, respectively. In addition, we found that the average operating time for the EDG was shorter than the LDG (55.5 minutes vs 77.9 minutes, respectively, p <0.001). Looking at 30-day outcomes we found that rates of readmission (0.9% vs 2.9%, p <0.001) and reoperation (0.8% vs 1.4%, p <0.001) were lower in the EDG than the LDG, respectively.

Our multivariate analysis (see figure) found that after the age of 55, every 10-year increase in age was associated with a subsequent decrease in the likelihood of early discharge. Within our cohort, BMI was directly related to discharge time with every 1-unit increase in BMI being associated with a 2% decrease in the likelihood of an early discharge (OR 0.98, 95% CI 0.97–0.99). Other factors such as smoking status and ASA scores were also negatively correlated with discharge times, where current smokers were 26% and patients with ASA scores of IV/V were 52% less likely to be discharged within 24 hours following colporrhaphy.

There were only 2 factors that our study found that were positively correlated with an early discharge. Our analysis revealed that procedures performed after 2012 were 2.41 times more likely to be discharged early than patients who had their procedure before 2013 (OR 2.41, 95% CI 2.20–2.64). This could be explained by the trend over the last decade in FPMRS surgery to implement Enhanced Recovery After Surgery (ERAS) pathways to increase the number of same-day discharges.⁶ Second, patients who underwent posterior colporrhaphy were 19% more likely to have an early discharge than patients who had a combined anterior–posterior colporrhaphy (OR 1.19, 95% CI 1.07–1.32). This suggests that, relative to isolated posterior colporrhaphy, anterior or combined colporrhaphy procedures are more complex and have potentially higher complication rates and longer hospital stays.

In summary, our results showed that outpatient colporrhaphy can be safely performed without increased early complications or readmissions, helping to validate the current standard of practice. In the preoperative setting, it is important to counsel women who are older, current smokers, or have higher BMIs and ASA scores, and to discuss how longer operating times all may contribute to longer hospital stays (>24 hours) following their colporrhaphy. In the era of ERAS protocols and increasing pressures for value-based care, same-day discharge will only continue to grow. Future research efforts should focus on how to optimize outcomes and patient experience with same-day discharge as the standard. Furthermore, more research is needed to extend the recommendation for same-day discharge following minimally invasive major prolapse repair, and hence support that most FPMRS procedures can be safely performed as outpatient procedures.

Research conducted at the Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.