Implementation of a Standardized, Same-Day Discharge Postoperative Void Trial Protocol in Urogynecology Patients—A Quality Improvement Project

INTRODUCTION: Postoperative void trials are common after urogynecology procedures. Implementation of void trials are varied and may result in prolonged catheterization with increased risk of urinary tract infection risk, patient discomfort, and additional healthcare resource allocation. OBJECTIVE: Primary aim was to see a reduction of indwelling catheter time in outpatient surgical patients by implementation of a same-day discharge void trial protocol. Secondary aims included decreases in additional visits, adverse outcomes and total antibiotic usage within 2 weeks post-procedure. METHODS: A void trial protocol was created within a tertiary care safety-net hospital urogynecology division by combining prior published protocols and attending preferences (Figure 1). Prolonged catheterization was defined as patients discharged home with a Foley catheter on postoperative day (POD) #0. Duration of catheter use was recorded for each case for three months prior to and post-protocol implementation. Both clinical and postoperative staff were provided with a standardized protocol (Figure 1). The time between documented surgery end time and first void trial was collected. The two-week postoperative data was collected during the scheduled postoperative appointment via patient interview and chart review. RESULTS: A total of 82 patients were operated on during the study period with 44 participants undergoing postoperative void trial: 14 pre- and 30 post-implementation. The pre- and post-implantation data collection occurred from July 1, 2024, to September 30, 2024, and February 1, 2025, to April 30, 2025, respectively. The remaining 38 patients were excluded due inpatient admission or void trial not required prior to discharge as determined by attending. Increased post-implementation surgical numbers were due to faculty hiring. Surgical procedures were similar between groups and included minimally invasive hysterectomy, sacrocolpopexy, uterosacral ligament suspension, colpocleisis, midurethral sling, periurethral bulking, and site-specific vaginal repairs. Pre-implementation, void trials were performed on POD #2, and mean duration of catheterization was 46.1 hours, compared to 7 hours post-implementation, resulting in an 84.8% overall decrease in average indwelling catheter time (p<0.01). Post-implementation, mean catheterization time was 2.4 hours among the 21 of 30 patients with successful POD #0 void trial. Additional void trial clinical encounters decreased from 100% before implementation to 36.7% after (p<0.01, Table 1). Within the two-week postoperative period, there were no statistically significant changes in the number of ER visits, subsequent catheter placement, or antibiotic usage (Figure 2). CONCLUSIONS: A standardized, same-day discharge void-trial protocol in urogynecology patients can be safely implemented to decrease prolonged Foley catheter use and additional clinical encounters in a resource-strained setting without an associated increase in complications in the immediate postoperative period.Figure 1Figure 2Table 1