Effect of Voiding Policy on Post Anesthesia Care Unit Length of Stay for Minimally Invasive Hysterectomy

Objective: This study aims to evaluate a liberal postoperative voiding policy after minimally invasive hysterectomies to assess the impact of length of stay in the postoperative care unit (PACU).

Design: This is a retrospective interrupted time series study. Patients were identified from three months before and after the policy change, and a chart review was conducted of medical records. The study was powered to detect a difference of 60 minutes between the pre- and post-policy groups. Secondary outcomes included post operative urinary retention (POUR), postoperative readmission and urinary tract infections (UTI). Wilcoxon rank-sum tests and Fisher's exact tests were utilized to compare outcomes between the pre- and post-policy groups.

Setting: All surgeries were completed within the division of Minimally Invasive Gynecologic Surgery at a single academic institution.

Participants: Female patients aged 18 and older were included if they had undergone a minimally-invasive hysterectomy for benign indications between August 17, 2022 and February 17, 2023. Exclusion criteria included surgery for gynecologic cancer, concurrent incontinence or pelvic floor surgeries, or if patients had a history of urinary retention or bladder surgery.

Intervention: A new liberal voiding protocol that did not require patients to void prior to discharge.

Results: 65 patients were identified for the pre-policy group, and 54 in the post-policy group. There was insufficient evidence to detect a difference in PACU length of stay (median 302 minutes pre vs. 250 minutes post) or incidence of POUR or UTIs.

Conclusion: The study concluded that a liberal voiding protocol is a feasible policy change. Although there was no statistically significant difference in the PACU length of stay, there was a trend towards decreased length of stay as the median was lower for this group. The results point towards a liberal voiding policy being safe, without changes seen in rates of POUR or UTIs.