Effect of length of hospital stay on infection and readmission after minimally invasive hysterectomy

Objective: To assess the effect of length of hospital stay on postoperative outcomes after minimally invasive hysterectomy. Methods: A retrospective cohort analysis was conducted of women who underwent minimally invasive hysterectomy (vaginal or laparoscopic) for benign conditions between January 1, 2014 and December 31, 2016, using the American College of Surgeons National Surgical Quality Improvement Program database. Patient information and 30-day outcomes were compared using multivariable logistic regression after adjusting for patient demographics and medical and procedure variables. Results: The analysis included 31 347 patients. Women discharged the day after surgery were more likely to be African-American, older, have prior abdominal surgery, and a higher ASA classification. Prevalence of organ space infection and readmissions were lower in the same day discharge group. No differences between same-and next-day discharge were found for surgical site infection or urinary tract infection (adjusted odds ratios (aORs) 0.83 (95% [CI] 0.65-1.07; P=0.156) and 0.85 (95% CI 0.68-1.06; P=0.151), respectively). Same-day hospital discharge was associated with a reduced chance of readmission (aOR=0.68, 95% CI 0.54-0.87; P=0.002). Conclusion: Same-day hospital discharge after minimally invasive hysterectomy lowered the risk of readmission and did not increase the risk of postoperative complications.