Refining Same-Day Hysterectomy Discharge

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Innovations in Obstetrics & Gynecology | Winter 2022

Minimally invasive hysterectomies have a number of reduced risks compared to abdominal hysterectomies. The risk of blood loss and other complications is lower, and patients typically feel less post-operative pain.

Megan Billow, DOMegan Billow, DO

Clinicians at University Hospitals in Cleveland are performing these minimally invasive procedures and leveraging enhanced recovery protocols to send patients home on the same day. Experts at UH are also exploring how to better understand the success factors for same-day discharge following minimally invasive hysterectomies.

Recognizing a national trend

“After abdominal surgery, patients traditionally are admitted to the hospital for three or four days,” says Megan Billow, DO, Director of Minimally Invasive Surgery at University Hospitals Cleveland Medical Center.

Nationally, surgeons are performing more laparoscopic, robotic and vaginal hysterectomies. With this trend, the gynecologic surgery community has recognized that patients experience less postoperative pain. With patients up and moving the same day as surgery, it has become clear that not everyone requires a three- to four-day hospital stay following a minimally invasive hysterectomy.

Initially, there was concern about patient satisfaction. Would patients be unhappy without those post-operative observation days in the hospital? Dr. Billow and her colleagues have found that, following surgery, patients want to go home to their own beds.

“There are some studies indicating that there are higher rates of patient satisfaction associated with going home the same day,” she says.

Examining the Impact of COVID-19 on Same-Day Discharge

Initially, Dr. Billow and her team experienced challenges related to buy-in, as not all surgeons were eager to send their patients home on the same day. Then the COVID-19 pandemic hit.

Same-day discharge allows patients to receive the surgeries they need, decreases their risk of exposure to COVID and frees up much-needed hospital beds. “We’ve seen an increase in the number of surgeons that are more likely to send the patients home the same day,” Dr. Billow says.

Patients are also motivated to go home the same day to limit their exposure risk.

Looking closer at success factors

“The next step is looking at predictors of patients who will be successful in terms of going home on the same day,” Dr. Billow says. “I’m looking at readmission rates and lots of different factors that may predict outcomes and ability to have success with going home the same day as the hysterectomy.”

Social determinants of success for same-day discharge are among the factors Dr. Billow and her colleagues are examining. They will be asking about patients’ home lives, their caretakers and transportation options, as well as evaluating the impact of patient education. The results of this study will create an even more robust set of patient predictors for care teams to leverage.

Understanding how these factors influence the likelihood of same-day discharge success could be beneficial not only for benign minimally invasive hysterectomies but also for procedures performed in other gynecologic subspecialties. Some gynecologic cancer or pelvic organ prolapse patients could be candidates for same-day discharge following minimally invasive hysterectomies.

Coordinating enhanced recovery protocols

When UH first considered implementing this same-day discharge program, the surgical and nursing leadership teams discussed the benefits and barriers. Since then, these teams, along with the anesthesia and PACU teams, have coordinated closely to identify patients who are candidates for same-day discharge and help them through the entire enhanced recovery protocol.

To learn more about how UH is managing same-day discharge for minimally invasive hysterectomies, reach out to Dr. Billow at Megan.Billow@UHhospitals.org.

Contributing Expert:
Megan Billow, DO
Director, Minimally Invasive Surgery
University Hospitals Cleveland Medical Center
Assistant Professor of Reproductive Biology
Case Western Reserve University School of Medicine

 

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