Association of Living Alone and Same-Day Discharge After Hysterectomy for Benign Gynecologic Indications.

OBJECTIVE: To evaluate the association between social support status (living alone vs living with others) and same-day discharge rates among patients undergoing hysterectomy for benign indications. METHODS: We conducted a retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program 2021-2022 Participant Use File. Patients undergoing hysterectomy for benign indications were identified based on Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. The primary exposure was social support status, categorized as "Lives Alone" or "Lives with Others"; the primary outcome was same-day discharge, defined as discharge on the calendar day of surgery. Covariates included age, body mass index (BMI), race, ethnicity, diabetes, hypertension, surgical approach, and operative time. Multivariable logistic regression was performed to assess the association between living alone and same-day discharge, adjusting for relevant clinical and demographic factors. RESULTS: A total of 1,615 patients were included, with 30% living alone and 70% living with others. Overall, 26% of patients had same-day discharge. Same-day discharge occured less frequently among patients living alone (22%) compared with those living with others (28%) (odds ratio [OR] 1.3; P=.02; CI, 1.0-1.7). In multivariable analysis, living alone was associated with 32% higher odds of overnight stay compared with living with others (OR 1.3; 95% CI, 1.0-1.7; P=.047). Surgical approach was a strong predictor of discharge outcomes, with laparoscopic hysterectomy (OR 0.4; 95% CI, 0.3-0.6) associated with reduced odds of overnight stay compared with vaginal hysterectomy. Operative time more than 180 minutes was associated with a nonsignificant trend towards increased overnight stay (OR 1.2; 95% CI, 0.8-1.5). CONCLUSION: Living alone is associated with lower odds of same-day discharge after hysterectomy for benign indications, independent of clinical and demographic characteristics. These findings underscore the need to consider social support during preoperative planning to optimize discharge outcomes. Strategies to enhance home support may facilitate same-day discharge among patients living alone.