Historically, planning an overnight stay following total vaginal hysterectomy (TVH) with vaginal reconstruction has been standard practice. Recent research involving minimally invasive hysterectomy and robotic sacrocolpopexy has demonstrated safety and feasibility utilizing same day discharge (SDD). There is limited data, however, on same day discharge outcomes for TVH with vaginal reconstruction. This retrospective study evaluated surgeries performed by the Urogynecology Division at a community-based academic institution over two time periods. Overnight stay (OS) was the standard practice between December 2018 and February 2020, while same day discharge (SDD) was the standard practice from December 2020 to February 2022. All subjects who underwent TVH with vaginal reconstruction in these time periods were included. Primary outcomes were 30-day readmission rates, ED visits, and re-operations. Secondary outcomes analyzed the same variables at 90 days and determined the rate for successful same day discharge. Statistical analysis was performed with Mann-Whitney U Test for continuous variables and Fisher's Exact Test for categorical variables. A total of 340 subjects were analyzed: 155 (46%) in the overnight stay period and 185 (54%) in the same day discharge period. There were no differences in demographic data including age, race, ethnicity, and BMI. When evaluating 30-day readmission rates, there was no difference between overnight stay as standard practice verses same day discharge as standard practice (2.6% vs 3.8% respectively; p=0.76). ED visits within 30 days after surgery were evaluated and no difference between groups was found (OS 14.2% vs SDD 14.1%, p=1.0). Similarly, reoperations were analyzed with no difference found (OS 1.9% vs SDD 1.6%, p=1.0). At 90 days, readmissions (OS 3.9% vs SDD 4.3%, p=1.0), ED visits (OS 16.1% vs SDD 15.1%, p=0.88), and re-operations (OS 1.9% vs SDD 1.6%, p=1.0) were also not significantly different. Rates of postoperative urinary retention (OS 72.3% vs SDD 74.1%, p=0.71) and high-volume blood loss (EBL >200ml) (OS 26.5% vs SDD 26.5%, p=1.0) were similar. For the period of same day discharge as standard practice, 80% of the subjects were successfully discharged the same day. In this retrospective two cohort study, patients undergoing TVH with vaginal reconstructive surgery had similar outcomes with SDD as compared to an overnight stay. With no increased risk of 30 or 90-day readmissions, ED visits, or re-operation rates, safety of same day discharge was demonstrated. Furthermore, the vast majority (80%) of subjects were able to be discharged on the day of surgery, suggesting that patients are willing to accept this model. We believe that surgeons may feel reassured about planning for SDD following major pelvic reconstructive surgery.

Acute situational anxiety (ASA) surrounding surgery can have detrimental effects on a patient's response to anesthesia, postoperative recovery, pain, and satisfaction with surgery. There is limited data evaluating ASA in the urogynecology patient population. We, therefore, sought to evaluate ASA in patients undergoing pelvic reconstructive surgery (PRS). This pilot study performed at an independent academic institution evaluated presurgical anxiety levels in patients undergoing PRS. The 17-item Surgical Anxiety Questionnaire (SAQ) was utilized. The SAQ is a validated surgery-specific survey that was designed to incorporate both the theoretical and practical components of preoperative anxiety, with a focus on concerns about general health status, the surgical recovery process, and concerns about limited control and surgical procedures. The instructions on the SAQ ask patients to rate how worried or concerned they are about each item, with a five-point response scale labeled 'not at all', 'a little bit', 'moderately', 'very' and 'extremely'. Responses to each item were scored 0–4, respectively. The highest possible score on the survey is 68. Subjects who underwent surgery for vaginal prolapse were eligible. We estimated 20 patients would provide an adequate sample. The survey was administered on the day of surgery in the preoperative holding area after routine counseling. A Kruskal-Wallis Test was conducted to examine the association between use of anxiety medication and total anxiety score. Twenty patients completed the survey. The median age was 66.5 (IQR 19). Eleven patients underwent a hysterectomy at the time of PRS (55%), and 4 patients underwent a concomitant sling procedure (20%). Our median patient anxiety score was 16 (IQR 15) and our highest individual patient score was 41. The highest scoring matters of concern were "experiencing pain or discomfort after my surgery" (average score of 2.15 out of 4) and "how long will it take to return to my normal daily activities or hobbies" (average score of 2.3 out of 4). The lowest scoring topic of concern was "having an injection or receiving an IV", (average score of 0.3 out of 4). An additional question was added to the original SAQ to identify patients currently taking medication for an anxiety condition. Eight patients (40%) reported "yes". There was no association between anxiety medications and anxiety score. Although patients undergoing pelvic reconstructive surgery do experience worry or concern over postoperative pain and return to daily activities, their anxiety levels are overall low. Further studies would help establish risk factors for higher anxiety, and how to improve anxiety for future patients.

To describe patient perceptions regarding same day discharge (SDD) following major vaginal reconstructive surgery. In this prospective, single-cohort descriptive study, patients undergoing vaginal hysterectomy with pelvic reconstructive surgery were preoperatively enrolled. At both 2 weeks and 12 weeks postoperatively, surveys detailing experience with SDD, surgical recovery, and advice for prospective patients were completed. The Surgical Satisfaction Questionnaire (SSQ-8) and visual analog scale for pain were included. Demographic and surgical data were collected. Our primary outcome was question 7 of the SSQ-8 on the 12-week questionnaire: Looking back, if you "had to do it all over again" would you have the surgery again? Descriptive statistics were performed. Sixty patients were enrolled; 54 underwent surgery. The median age was 65.5 years (IQR 11.75), majority were white (n=52, 96%), and median BMI was 25.3 (IQR 6.65). Although 54 patients completed surgery, 47 were discharged the same day (87%). Forty-two patients having SDD completed the 12-week questionnaire (89%). At 12 weeks, 98% of patients (n=41) would have the surgery again, and 90% (n=38) were satisfied with the results of surgery. Forty patients (95%) had felt prepared to deal with their pain, and 86% of patients (n=36) felt comfortable with SDD. At 12 weeks postoperatively, the most common patient-reported complications were urinary tract infection (UTI; n=8, 19%), catheter concerns (n=4, 10%), and constipation (n=3, 7%). Eleven patients (26%) reported that the worst part of the surgical experience was being discharged with a catheter. When asked to list the best parts of their surgical experience, almost half of patients felt this was the office staff or physician themselves (n=14, 33%). Sixty percent of patients reported the result of surgery as one of the best parts of the surgical experience (n=25). When asked what advice they would provide to future patients undergoing this surgery, the most common responses described having a support person at home, taking time for recovery, and following the postoperative instructions. In this sample of women receiving SDD following vaginal hysterectomy with pelvic reconstruction, we present unique insight into the most common patient concerns postoperatively. Rates of satisfaction and comfort with SDD were high. Patients felt the relationship with the office staff and their surgeon were the best parts of their surgical experience.