Generalizability of ERAS-Driven Same Day Discharges for Benign and Malignant Hysterectomies in a Rural Population: A Single Institution Retrospective Study

INTRODUCTION: ACOG endorsed ERAS pathways in the perioperative care of patients undergoing gynecologic surgery. Notably, many of the studies on safety and feasibility of same-day discharges (SDD) come from institutions based in large metropolitan cities—one study cited a median one-way distance traveled as 31.5 miles, with another excluding those who traveled >2 hours in one direction. No studies have evaluated the feasibility and outcomes of SDD at a tertiary rural medical center. OBJECTIVE: The primary objective was to determine if a greater distance from the hospital decreased likelihood of SDD for minimally invasive hysterectomy, with the secondary objective attempting to identify any influential patient or case factors. METHODS: This single institution, IRB-approved retrospective study evaluated patients >18 years old who underwent a minimally invasive (robotic or laparoscopic) hysterectomy with/without removal of adnexal structures or pelvic lymph nodes for benign/malignant indications between 1/2023 and 12/2023. Cases were excluded if they were combined with another specialty, incarcerated, went to the ICU postoperatively, or included any radical surgery or debulking. Data were analyzed via SPSS software via appropriate statistical testing. RESULTS: 418 cases met study criteria; patient characteristics and outcomes are detailed in Table 1. 27.5% (n=115) patients were SDD. Non-SDD patients were more likely to be older (p<0.001), report larger BMIs (p=0.014), and have more medical comorbidities with higher Charlson Comorbidity indices (p<0.001). Patients who lived <100 miles from the hospital were more likely to undergo SDD (p=0.011). Benign gynecologists (including MIGS) were more likely than gynecologic oncologists to have SDD patients (<0.001), with earlier time of case start (p<0.001), less intraoperative crystalloid use (p=0.003), and immediate postoperative removal of indwelling urinary catheter (<0.001) were additionally associated with SDD. Minimally invasive approach, uterine weight, and use of local anesthetic did not appear to significantly impact likelihood of SDD. Postoperative outcomes, including patient calls within 30 days, emergency department visits, return to the operating room, and morbidity/mortality were all found to be non-significant between groups. CONCLUSIONS: Distance from hospital was found to significantly impact SDD; there was no significant difference in observed patient outcomes between the two groups including readmissions, reoperations, number of phone calls, or morbidity. In addition, patient, operative, and health system factors appeared to also significantly impact the likelihood of SDD, representing opportunities for intervention and intentional utilization of resources.