Nonhome Discharge in Patients Undergoing Pelvic Reconstructive Surgery: A National Analysis

Abstract

Importance Discharge to home after surgery has been recognized as a determinant of long-term survival and is a common concern in the elderly population. Objective The aim of the study was to determine the incidence and risk factors for nonhome discharge in patients undergoing major surgery for pelvic organ prolapse. Study Design We performed a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program Database from 2010 to 2018. We included patients who underwent sacrocolpopexy, vaginal colpopexy, and colpocleisis. We compared perioperative characteristics in patients who were discharged home versus those who were discharged to a nonhome location. Stepwise backward multivariate logistic regression was then used to control for confounding variables and identify independent predictors of nonhome discharge. Results A total of 38,012 patients were included in this study, 209 of whom experienced nonhome discharge (0.5%). Independent predictors of nonhome discharge included preoperative weight loss (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 1.3–27.5), dependent health care status (aOR, 5.0; 95% CI, 2.6–9.5), abdominal hysterectomy (aOR, 2.3; 95% CI, 1.4–3.7), American Society of Anesthesiologists class 3 or greater (aOR, 2.0; 95% CI, 1.5–2.7), age (aOR, 1.1; 95% CI, 1.05–1.09), operative time (aOR, 1.005; 95% CI, 1.003–1.006), laparoscopic hysterectomy (aOR, 0.6; 95% CI, 0.4–1.0), and laparoscopic sacrocolpopexy (aOR, 0.5; 95% CI, 0.3–0.8). Conclusions In patients undergoing surgery for pelvic organ prolapse, nonhome discharge is associated with various indicators of frailty, including age, health care dependence, and certain comorbidities. An open surgical approach increases the risk of nonhome discharge, while a laparoscopic approach is associated with lower risk.