UPJ INSIGHT: Patient Perspectives toward Undergoing Same-Day Discharge for Apical Pelvic Organ Prolapse Repair Surgery during the COVID-19 Pandemic

By: Megan Mathew, BS; Alejandra Guevara Mendez, MD; Raveen Syan, MD; Laura Martin, DO; Katherine Amin, MD | Posted on: 01 Jun 2022

Mathew M, Mendez AG, Syan R et al: Patient perspectives toward undergoing same-day discharge for apical pelvic organ prolapse repair surgery during the COVID-19 pandemic. Urol Pract 2022; 9: 229.

Study Need and Importance

Nearly 220,000 pelvic organ prolapse (POP) repair surgeries are performed annually, with the number increasing yearly. Because these procedures are typically elective, many were postponed or cancelled during the COVID-19 pandemic. However, POP symptoms cause a significant burden on quality of life. Advancements in surgical techniques have resulted in a growing trend for same-day discharge (SDD) following complex procedures. This study assessed patient perspectives following SDD after transvaginal and minimally invasive apical POP repair during the pandemic.

Table. Results for overall satisfaction and COPS-D (for Core questionnaire for the assessment of Patient Satisfaction for general Day care) questionnaire for 29 SDD patients

	No. Unsatisfied (%)	No. Somewhat Satisfied (%)	No. Rather Satisfied (%)	No. Quite Satisfied (%)	No. Very Satisfied (%)
Overall satisfaction	1 (3)	0	1 (3)	4 (14)	23 (79)
Preop visit	0	0	1 (3)	3 (10)	25 (86)
Admission	0	1 (3)	0	1 (3)	27 (93)
Operating theater	0	0	0	2 (8)	24 (92)
Nursing care	3 (10)	0	1 (3)	1 (3)	24 (83)
Medical care	0	0	0	0	29 (100)
Information	0	1 (3)	2 (7)	3 (10)	23 (79)
Autonomy	0	1 (3)	1 (3)	0	27 (93)
Discharge	1 (3)	0	3 (10)	3 (10)	22 (76)

What We Found

Over 80% of patients preferred SDD preoperatively (30/36). When rating the influence of COVID-19 on their preference (1–10, 10=high), approximately a third reported level 10 and nearly another third reported level 1 (mean±SD 5.9±4.0). Six patients were above the age of 70, all of whom underwent SDD successfully. Among the various types of procedures performed for patients who were discharged on postoperative day 0, 54.8% were transvaginal apical repairs with vaginal hysterectomy, 29.0% were robotic-assisted laparoscopic sacrocolpopexy with supracervical hysterectomy, 12.9% were transvaginal apical repairs without vaginal hysterectomy and 3.2% were laparoscopic sacrocolpopexy procedures. Of the patients 89.7% reported feeling safer with SDD. Five patients were admitted and 2 would have preferred SDD. Of the SDD patients 82.8% rated their overall experience as “very satisfied” and consistently rated individual components of ambulatory care highly (see Table).

“As the COVID-19 pandemic persists and variants emerge, health care systems must develop ways to navigate elective surgery safely, improve patient experiences and align goals of care.”

Limitations

This study included a small heterogeneous cohort size, with 36 patients recruited, and characterizes the preferences and outcomes of mostly White female patients, which may not represent the general population with POP. No comparison group was analyzed because few patients were admitted overnight. This study was conducted in a south Florida COVID-19 “hotspot;” however, rates of COVID-19, hospital safety measures and perception of the pandemic varied within the United States.

Interpretation for Patient Care

As the COVID-19 pandemic persists and variants emerge, health care systems must develop ways to navigate elective surgery safely, improve patient experiences and align goals of care. SDD following minimally invasive apical POP repair appears to be preferred among our patient population during the pandemic with high success and satisfaction rates, and in the absence of one can be utilized successfully and safely in future practice to increase patient satisfaction.