Same-Day Discharge With Early Telehealth Follow-Up After Minimally Invasive Benign Gynecologic and Urogynecologic Surgery: Healthcare Utilization, Safety, and Direct Costs.

Abstract

Background: Same-day discharge and early telehealth follow-up are increasingly combined after minimally invasive benign gynecologic and urogynecologic surgery, but pathway-level evidence is limited. We evaluated the observed combination of same-day discharge and a completed telehealth contact within 48-72 hours in relation to 30-day healthcare utilization, direct institutional cost, recovery, and adverse events.

Methods: This retrospective single-center cohort included 289 consecutive patients treated between January 2023 and April 2026. The comparative cohort comprised 212 patients eligible for same-day discharge; 211 had complete covariate data. Four observed pathways were defined by discharge status and telehealth completion. The primary analysis used generalized propensity-score overlap weighting. Pairwise doubly robust estimators, conventional adjustment, a binary pathway-completion analysis, and a full-cohort model served as supportive or sensitivity analyses.

Results: The combined pathway was completed by 142 of 212 eligible patients (67.0%). In the primary weighted comparison with no same-day discharge/no telehealth, it was not associated with lower 30-day healthcare utilization (risk ratio 0.72, 95% confidence interval 0.47-1.09; p = 0.122). A binary comparison with all other pathways was also null (risk ratio 1.00, 95% confidence interval 0.68-1.48; p = 0.987). Pairwise augmented inverse probability weighting and targeted maximum likelihood estimation both yielded a risk ratio of 0.61 (95% confidence interval 0.41-0.81; p < 0.001), but residual imbalance remained, estimates varied by method, and these pairwise estimates are susceptible to exposure-timing bias and are not interpreted as causal. Mean nominal direct cost was 56,601 versus 69,882 Turkish lira (cost ratio 0.87, 95% confidence interval 0.83-0.91; p < 0.001). Because the ratio compares contemporaneous groups, it was robust to inflation across the study period. Median time to return to normal activity was 13.25 versus 16.4 days and was descriptive only. Any 30-day safety event occurred in 15.5% versus 28.9% (penalized odds ratio 0.45, 95% confidence interval 0.19-1.02; p = 0.057).

Conclusions: The observed same-day-discharge-plus-telehealth pathway was consistently associated with lower direct institutional cost across analytic approaches, whereas evidence for a reduction in 30-day healthcare utilization was not robust across methods. Given the observational design, potential exposure-timing bias, limited effective sample size, and residual confounding, these associations should not be interpreted as causal effects of the pathway on healthcare utilization or clinical outcomes. No clear excess of short-term adverse events was identified, although safety equivalence was not established. Prospective multicenter studies should account explicitly for the timing of telehealth completion.