A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hour day case surgery setting : Reply

Department of Obstetrics and Gynaecology, University Hospital of Wales, Heath Park, Cardiff, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 05/2007; 114(4):430-6. DOI: 10.1111/j.1471-0528.2007.01269.x
Source: PubMed


To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery.
Prospective observational study.
A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology.
Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population.
Prospective observational study.
The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women.
Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies.
Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike.

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Available from: Richard J.A. Penketh, Aug 30, 2015
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    • "Spinal anaesthesia may be an alternative for abdominal or vaginal hysterectomy allowing for less postoperative morphine demands, but the use of intrathecal morphine also includes more postoperative itching (Sprung, 2006; Massicotte, 2009; Wodlin, 2011). Fasttrack programmes using spinal anaesthesia with intrathecal morphine may even be associated with improved quality of life measures several weeks after surgery compared to general anaesthesia, because even minor complications adversely affect the mental component of quality of life and duration of sick leave (Ottesen, 2002; Penketh, 2007; Wodlin, 2011). General anaesthesia counteracts the cardiovascular effects of the physiological stress response by dilating peripheral vasculature, reducing cardiac output, blood pressure and heart rate in a dose-dependent fashion. "

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