Patient perceptions of same-day discharge after minimally invasive gynecologic and pelvic reconstructive surgery.

BACKGROUND: Studies have demonstrated that same-day discharge after minimally invasive gynecological and pelvic reconstructive surgery is safe and cost effective and does not result in increased readmissions when compared with inpatient surgery. However, few studies have assessed patient satisfaction with same-day discharge after minimally invasive gynecological and pelvic reconstructive surgery. Increased knowledge of patients' values allows for evidence-based, patient-centered perioperative care and guides perioperative counseling.

OBJECTIVES: The objectives of the study were to evaluate patient perceptions of same-day discharge after minimally invasive gynecological and pelvic reconstructive surgery, to identify barriers to patient acceptance of same-day discharge, and to assess changes in patient acceptance before and after reading an evidence-based statement regarding same-day discharge.

STUDY DESIGN: This is a cross-sectional survey study. All English-speaking new patients presenting to a subspecialty, benign gynecological surgery clinic, including female pelvic medicine and reconstructive surgery and minimally invasive gynecologic surgery providers, were invited to participate. The survey included an evidence-based statement about same-day discharge. Participants were asked to rate their comfort with same-day discharge before and after reading this statement.

RESULTS: Ninety-six percent of women (208 of 216) who were approached completed the study. The majority rated their overall health and mental or emotional health as good or very good (61.1% and 64.9%). Most (82.7%) completed at least some college. Most (86.1%) reported having at least 1 prior surgery and 68.8% reported same-day discharge after a prior surgery: 74.8% rated their prior experience with same-day discharge favorably. The majority of respondents (86.1%) reported they would feel comfortable with same-day discharge. The most important cited reasons for going home the same day as surgery included sleeping in own bed (73.4%) and being with family (61.8%). The most important cited reasons for staying overnight in the hospital included anticipated better pain control (58.9%) and decreased overall complications (43.0%). Forty percent believed it would be easier to take care of a catheter if needed in the hospital. Patients who reported living alone and those 65 years old and older were less likely to feel comfortable with same-day discharge (odds ratio, 0.39, 95% confidence interval, 0.17-0.91). Of the 29 patients who reported at baseline that they would not feel comfortable with same-day discharge, most (65.5%) changed their minds after reading an evidence-based statement about same-day discharge. When asked if their surgeon recommended it, almost all patients (96.1%) reported they would feel comfortable with same-day discharge.

CONCLUSION: Among new patients presenting to a subspecialty, benign gynecologic surgery clinic including female pelvic medicine and reconstructive surgery and minimally invasive gynecological surgery providers, most perceive same-day discharge favorably following minimally invasive gynecological and pelvic reconstructive surgery. Women who live alone and those aged 65 years and older feel less comfortable with same-day discharge. While an evidence-based statement regarding the benefits and safety of same-day discharge further improves patient acceptance, direct surgeon counseling may be more important to establish discharge goals.