Compared to inpatient surgery, outpatient surgery has the advantages of an easier in-home recovery time, reduced stress, predictable scheduling, and lower healthcare costs.[1] Additionally, outpatient surgery is associated high patient satisfaction in several reports.[2] Contemporary reports on perioperative morbidity of outpatient versus inpatient pelvic organ prolapse surgeries are scarce. This study compare 30-day postoperative complications between early (≤1 day) versus late (>1 day) discharge following colporrhaphy, and also determine the factors that are associated with early postoperative complications following colporrhaphy.

The National Surgical Quality Improvement Program (NSQIP) database of the American College of Surgeons was utilized to extract the study cohort from 2005-2016. Female patients with at least 18 years of age who underwent colporrhaphy as the primary procedure were identified. The colporrhaphy procedure (either anterior, posterior, or combined) was identified using the following current procedural terminology (CPT) codes: 57240, 57250, 57260 and 57265. We excluded patients who had concurrent colpopexy, colpocleisis, hysterectomy, perineoplasty, oophorectomy, urethral plication, vulvectomy, cervicectomy, sphincteroplasty, vaginectomy, cystostomy, or vesicourethropexy. Patients were categorized according to length of hospital stay into same day hospital discharge/outpatient group (OPG) and >1 day/inpatient group (IPG). Patient characteristics, pre-operative labs, American Society of Anesthesiologists (ASA) Classification, whether colporrhaphy was received with concomitant sling procedure, operating time, 30-day readmission, reoperation and complications were recorded. Descriptive statistics were used to compare patient characteristics and complications between the two groups. Multivariable logistic regressions determined factors associated with increased risk of postoperative complications following colporrhaphy. Adjusted odds ratios (aOR) and 95% CIs were reported. All analyses were conducted using SAS v9.4 (SAS Institute Inc., Cary, NC). All statistical inference were made based on p=0.05 significance level.

Of 11,652 females receiving colporrhaphy, 32% (n=3,728) were OPG and 68% (n=7,924) were IPG. Patients in IPG were older than those in OPG (16.8% of patients aged ≥ 75 years in IPG vs. 10.9% in OPG, p<0.001). Generally, patients in IPG were sicker (higher ASA class), had higher body mass index, more likely to be current smokers, and required longer operating time than those in OPG. 74% of patients in OPG received their surgery in or after 2013 compared to 53.8% of the patients in IPG (p<0.001). Compared to OPG, more proportion of patients in IPG were white, had abnormal hematocrit (<45%), had abnormal while blood cell count (WBC) (<4,000 or >11,000) and received combined colporrhaphy and concomitant sling. Mean length of stay in IPG was 2.4±1.6 days. Mean operating time (minutes) was shorter in OPG vs. IPG (55±34 vs. 78±47, p<0.001). The overall 30-day morbidity (3.7% vs. 6.2%, aOR=0.67 [0.55–0.82]), reoperation (0.8% vs. 1.4%, OR=0.59 [0.39–0.90]), and readmission (0.9% vs. 2.4%, OR=0.40 [0.26–0.90]) were significantly lower in OPG versus IPG. Factors that independently associated with higher risk of early postoperative complications in both groups were white race (aOR [95%CI] =1.89 [1.17-4.82]), ASA class IV/V (vs. I/II) (1.23 [1.01-1.5]), preoperative abnormal WBC count (1.48 [1.14-1.91]), longer operating time (10-minute increment) (1.05 [1.04-1.07]) and receiving anterior colporrhaphy (vs. combined) (1.22 [1.00-1.49]). Unexpectedly, older age groups (45-54) and (55-64) were associated with lower risk of early postoperative complications (0.69 [0.51-0.92] and 0.69 [0.52-0.90], respectively).

Based on a national database, our results showed that electing to perform outpatient colporrhaphy would not increase the rate of early postoperative complications, readmission and reoperation. Following colporrhaphy, factors associated with increased risk of postoperative complications were white race, higher ASA class, abnormal WBC count, longer operating time and undergoing anterior rather than combined colporrhaphy procedure. These factors should be considered during patient counseling prior to colporrhaphy procedure.

Outpatient colporrhaphy was associated with lower 30-day morbidity compared to inpatient. Generally, white race, higher ASA class, abnormal WBC count, longer operating time and undergoing anterior colporrhaphy rather than combined were associated with higher risk of early postoperative complications following colporrhaphy. Cooperative prospective studies to confirm these observations are warranted.

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