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Wehr M, Lecointre L, Schneider H, Schwartz L, Faller E, Boisramé T, Baldauf JJ, Akladios C. [Outpatient laparoscopic hysterectomy in France: A monocentric randomized trial]. ACTA ACUST UNITED AC 2021; 50:33-39. [PMID: 34509670 DOI: 10.1016/j.gofs.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of outpatient laparoscopic hysterectomy using the assessment of post-operative quality of life. METHODS A prospective randomized single-center trial was performed in France between 2013 and 2016. A total of 42 patients needed laparoscopic hysterectomy was included. Postoperative quality of life was assessed using the standardized Euroquol questionnaire. Patients filled the score before the operation and then on the 3rd and 30th postoperative day. Secondary outcomes were assessment of postoperative pain, overall quality of life, analgesic use, and anxiety. The patients were randomized into two groups, group A with a conventional hospital stay of 2 to 3 days and group B with a short stay and a discharge the day after the intervention. RESULTS Twenty-one patients were randomized to group A as well as group B. We did not find any significant differences between the two groups in our study either on our primary outcome or in the seconds ones. On day 3, the average of Euroquol score was 0.68 for group A against 0.50 for group B (P=0.05). Likewise, the scores for postoperative pain were similar with 70.6 in group A and 61.8 in group B (P=0.21). The trend was the same for quality of life score or anxiety. CONCLUSION Our study shows the possibility and the safety of outpatient laparoscopic hysterectomy.
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Affiliation(s)
- M Wehr
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - L Lecointre
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357 laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, université de Strasbourg, 67081 Strasbourg, France; Institut hospitalo-universitaire (IHU) Institute for Minimally Invasive Hybrid Image-Guided Surgery, université de Strasbourg, 67081 Strasbourg, France.
| | - H Schneider
- Centre hospitalier de Saverne, Saverne et Haguenau, France.
| | - L Schwartz
- Centre hospitalier de Haguenau, Saverne et Haguenau, France.
| | - E Faller
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - T Boisramé
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - J-J Baldauf
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - C Akladios
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
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Dolivet E, Foulon A, Simonet T, Sanguin S, Turck M, Pizzoferrato AC, Fauvet R. AMeTHYST (AMbulatory HYsterectomy surgery). Feasibility of minimally invasive outpatient hysterectomy, a preliminary study. Eur J Obstet Gynecol Reprod Biol 2020; 252:412-417. [PMID: 32712532 DOI: 10.1016/j.ejogrb.2020.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hysterectomy, one of the most frequent surgical procedures in women, is commonly performed by a minimally-invasive approach (laparoscopic or vaginal) as recommended by the French guidelines. The French authorities aim to have 66 % of all procedures performed as same-day surgery in 2020. The aim of this study was to evaluate the feasibility and identify factors associated with success or failure of same-day surgery for minimally-invasive hysterectomy. STUDY DESIGN We conducted a prospective double-center observational study at the Caen and Amiens University Hospitals between September 2017 and May 2018 including hospitalized patients managed for a laparoscopic or vaginal hysterectomy. Patients were younger than 70 and have no major medical problems. The patients were placed into a "fit" or "unfit" group according to their Post Anaesthetic Discharge Scoring System (PADSS) score 6 h post-surgery. All the patients were asked to complete an assessment questionnaire during their hospitalization. RESULTS Of the 50 included patients, half were placed in the "fit" group. A history of laparotomy was significantly predictive of failure of same-day discharge (p = 0.003) but not uterine size or Body Mass Index (BMI). The main barriers for discharge were pain (p<0.001) and postoperative nausea/vomiting (PONV) (p<0.001). Four patients, all in the "unfit" group, had Clavien-Dindo grade 1 postoperative complications. CONCLUSION Same-day minimally invasive hysterectomy is a feasible and safe procedure. Factors associated with same-day hysterectomy failure were laparotomy, pain and postoperative nausea/vomiting.
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Affiliation(s)
- Enora Dolivet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Surgery Department, Centre François Baclesse, Caen, France
| | - Arthur Foulon
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Thérèse Simonet
- Department of Anesthesiae, University Hospital of CAEN, France
| | - Sophie Sanguin
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Mélusine Turck
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Anne-Cécile Pizzoferrato
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Raffaèle Fauvet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Caen Normandie University, Inserm U1086 « ANTICIPE », Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), France.
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3
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[Outpatient hysterectomy: criteria for acceptability and feasibility, survey among 152 surgeons]. ACTA ACUST UNITED AC 2020; 48:153-161. [PMID: 31953208 DOI: 10.1016/j.gofs.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to determine one-day hysterectomy's criteria of acceptability and feasibility. MATERIALS AND METHODS We realized an observational descriptive survey based on questionnaires which were sent to gynecologic surgeons. Criteria were defined as major when rate of favorable responses was superior to 70%. RESULTS Main major criteria were: definition of an age limit (80.3% of respondents), of a Body Mass Index limit (70%), no history of coronary artery disease (77.6%), no anticoagulant therapy with curative intent (95.4%) or antiplatelet (71.1%), no history of sleep apnea (77.4%), surgery within two hours (85.1%), definition of intraoperative bleeding limit (87.5%), no laparotomy (97.4%), no intra abdominal drainage (77.6%), presence of an accompanying at home (99.3%), pain evaluation (97.4%), absence of nausea before leaving (75.5%) and spontaneous urination (96.7%). CONCLUSION Our study determined major criteria to practice one-day hysterectomy. Decision should be based on a personalized benefice-risk balance analysis. Final decision belongs to patient, as her complete engagement is fundamental.
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Pontvianne M, Riss J, Goillot V, Aubry G, Lecointre L, Akladios C. [Ambulatory minimally invasive hysterectomy: Limiting factors related to health professionals]. ACTA ACUST UNITED AC 2019; 47:831-835. [PMID: 31614229 DOI: 10.1016/j.gofs.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The feasibility of minimally invasive hysterectomy for ambulatory benign pathology has been demonstrated in many international studies. France has a considerable delay of multifactorial origin in this field. The objective of this study is to identify the limiting factors related to health professionals to the realization of minimally invasive ambulatory hysterectomy and to determine possible strategies to increase its rate. METHODS This is a cross-sectional survey conducted over 2 months using a self-administered questionnaire sent by email to 180 gynecological surgeons in 2 French regions (Grand Est and Bourgogne-Franche Comté). RESULTS A total of 22% of health professionals responded to the survey. The vast majority of practitioners (60%) said they did not carry out ambulatory care by habit. The apprehension of the reaction of the patients (47.5%), the fear of delayed diagnosis of complications (12.5%), the management of pain in the postoperative period (42.5%) also participated in brake of the promotion of ambulatory care. DISCUSSION Improvement of the organisation of city and hospital management allowing a better continuity of care (70%), the economic valuation (37.5%) and the increase in the hourly amplitude of the ambulatory surgery unit (5%) would improve the rate of ambulatory care of minimally invasive hysterectomies, according to the gynecologist surgeons surveyed. In addition, a prospective study evaluating the quality of life of patients after ambulatory care of minimally invasive hysterectomy would allow better adherence of health professionals and patients to the ambulatory care project in 70% of cases. CONCLUSION The change of mentality of health professionals remains a priority for the promotion of ambulatory surgery in gynecology. Information and communication are therefore essential to the expansion of the ambulatory.
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Affiliation(s)
- M Pontvianne
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France.
| | - J Riss
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France
| | - V Goillot
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France
| | - G Aubry
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
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Keil DS, Schiff LD, Carey ET, Moulder JK, Goetzinger AM, Patidar SM, Hance LM, Kolarczyk LM, Isaak RS, Strassle PD, Schoenherr JW. Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery. Anesth Analg 2019; 129:776-783. [PMID: 31425219 DOI: 10.1213/ane.0000000000003339] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) pathways in gynecologic surgery have been shown to decrease length of stay with no impact on readmission, but no study has assessed predictors of admission in this population. The purpose of this study was to identify predictors of admission after laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RAH) performed under an ERAS pathway. METHODS This is a prospective observational study of women undergoing LH/RAH for benign indications within an ERAS pathway. Data collected included same-day discharge, reason for admission, incidences of urgent clinic and emergency room (ER) visits, readmissions, reoperations, and 9 postulated predictors of admission listed below. Patient demographics, markers of baseline health, and clinical outcomes were compared between groups (ERAS patients discharged on the day of surgery versus admitted) using Fisher exact and Student t tests. Multivariable logistic regression was used to assess the potential risk factors for being admitted, adjusting for age, race, body mass index, American Society of Anesthesiologists (ASA) physical status score, preoperative diagnosis indicative of hysterectomy, preoperative chronic pain, completion of a preprocedure pain-coping skills counseling session, procedure time, and compliance to the ERAS pathway. RESULTS There were 165 patients undergoing LH/RAH within an ERAS pathway; 93 (56%) were discharged on the day of surgery and 72 were admitted. There were no significant differences in ER visits, readmissions, and reoperations between groups (ER visits: discharged 13% versus admitted 13%, P = .99; 90-day readmission: discharged 4% versus admitted 7%, P = .51; and 90-day reoperation: discharged 4% versus admitted 3%, P = .70). The most common reasons for admission were postoperative urinary retention (n = 21, 30%), inadequate pain control (n = 21, 30%), postoperative nausea and vomiting (n = 7, 10%), and planned admissions (n = 7, 10%). Increased ASA physical status, being African American, and increased length of procedure were significantly associated with an increased risk of admission (ASA physical status III versus ASA physical status I or II: odds ratio [OR], 3.12; 95% confidence interval [CI], 1.36-7.16; P = .007; African American: OR, 2.47; 95% CI, 1.02-5.96; P = .04; and length of procedure, assessed in 30-minute increments: OR, 1.23; 95% CI, 1.02-1.50; P = .04). CONCLUSIONS We were able to define predictors of admission for patients having LH/RAH managed with an ERAS pathway. Increased ASA physical status, being African American, and increased length of procedure were significantly associated with admission after LH/RAH performed under an ERAS pathway. In addition, the incidences of urgent clinic and ER visits, readmissions, and reoperations within 90 days of surgery were similar for patients who were discharged on the day of surgery compared to those admitted.
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Affiliation(s)
- Dayley S Keil
- From the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Lauren D Schiff
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Erin T Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Janelle K Moulder
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Amy M Goetzinger
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Seema M Patidar
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Lyla M Hance
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Lavinia M Kolarczyk
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Robert S Isaak
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jay W Schoenherr
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Barr Grzesh RL, Treszezamsky AD, Fenske SS, Rascoff LG, Moshier EL, Ascher-Walsh C. Use of Paracervical Block Before Laparoscopic Supracervical Hysterectomy. JSLS 2018; 22:JSLS.2018.00023. [PMID: 30356343 PMCID: PMC6174006 DOI: 10.4293/jsls.2018.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Some patients who undergo laparoscopic hysterectomy request overnight admission for pain management, thus increasing costs for a surgery that is safe for same-day discharge. We wanted to evaluate whether a paracervical block of bupivacaine with epinephrine before laparoscopic supracervical hysterectomy would decrease overnight admission rates, postoperative pain, and pain medication requirement Methods: This was a randomized, double-blind, placebo-controlled, parallel-group trial (Canadian Task Force classification I) at an academic medical center. Patients undergoing laparoscopic supracervical hysterectomy were randomized to a 20-mL paracervical injection of either 0.25% bupivacaine with epinephrine or 20 mL normal saline before skin incision. All providers, except the circulating nurse, were blinded. The primary outcome was overnight hospital admission rate. Secondary outcomes included postoperative pain medication use and pain scores. Analysis included t test, χ2, Wilcoxon, and ANOVA. Results: One hundred thirty-two patients were enrolled—68 in the treatment group and 64 in the placebo group. Demographics were similar between groups. The unplanned overnight admission rate was 34% for the treatment group and 27% for the placebo group (P = .25). After discharge, the treatment group used on average 8.5 tablets of narcotics, whereas the placebo group used 11.7 tablets (P = .07). The treatment group took 13.1 tablets of nonnarcotic analgesics compared to 11.2 in the placebo group (P = .57). Both groups reported similar pain scores. Conclusion: Paracervical block with bupivacaine and epinephrine before laparoscopic supracervical hysterectomy did not decrease overnight admission rate or affect postoperative pain. Postoperative opiate use was minimally decreased.
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Affiliation(s)
- Rachel L Barr Grzesh
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | | | - Suzanne S Fenske
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | - Lauren G Rascoff
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | - Erin L Moshier
- Division of Biostatistics, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles Ascher-Walsh
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
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7
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Gale J, Thompson C, Lortie KJ, Bougie O, Singh SS. Early Discharge after Laparoscopic Hysterectomy: a Prospective Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1154-1161. [DOI: 10.1016/j.jogc.2017.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 11/26/2022]
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8
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Nensi A, Coll-Black M, Leyland N, Sobel ML. Implementation of a Same-Day Discharge Protocol Following Total Laparoscopic Hysterectomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:29-35. [DOI: 10.1016/j.jogc.2017.05.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/19/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
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9
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Dedden SJ, Geomini PM, Huirne JA, Bongers MY. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 216:212-223. [DOI: 10.1016/j.ejogrb.2017.07.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
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10
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Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study. Surg Endosc 2016; 31:3363-3369. [PMID: 27844235 PMCID: PMC5501901 DOI: 10.1007/s00464-016-5333-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/31/2016] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gender-affirming surgeries in female-to-male (FtM) transgender patients include mostly hysterectomy, bilateral salpingo-oophorectomy and mastectomy. Sometimes further surgery is performed, such as phalloplasty. Colpectomy may be performed to overcome gender dysphoria and disturbing vaginal discharge; furthermore, it may be important in reducing the risk of fistulas due to the phalloplasty procedure with urethral elongation. Colpectomy prior to the reconstruction of the neourethra seems to reduce fistula rates on the very first anastomosis. Therefore, at our center, colpectomy has become a standard procedure prior to phalloplasty and metoidioplasty with urethral elongation. Colpectomy is known as a procedure with potentially serious complications, e.g., extensive bloodloss, vesicovaginal fistula or rectovaginal fistula. Colpectomy performed via the vaginal route can be a challenging procedure due to lack of exposure of the surgical field, as many patients are virginal. Therefore, we investigated whether robot-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH-BSO) followed by robot-assisted laparoscopic colpectomy (RaLC) is an alternative for the vaginal approach. METHODS Robot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study. RESULTS Median length of the procedure was 230 min (197-278), which reduced in the second half of the patients, median blood loss was 75 mL (30-200), and median discharge was 3 days (2-3) postoperatively. One patient with a major complication (postoperative bleeding with readmission and transfusion) was reported. CONCLUSION To our knowledge, this is the first report of RaLC. Our results show that RaLC combined with robot TLH-BSO is feasible as a single-step surgical procedure in FtM transgender surgery. Future studies are needed to compare this technique to the two-step surgical approach and on its outcome and complication rates of subsequent phalloplasty.
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Rendón GJ, Echeverri L, Echeverri F, Sanz-Lomana CM, Ramirez PT, Pareja R. Outpatient laparoscopic nerve-sparing radical hysterectomy: A feasibility study and analysis of perioperative outcomes. Gynecol Oncol 2016; 143:352-356. [DOI: 10.1016/j.ygyno.2016.08.233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/29/2016] [Accepted: 08/06/2016] [Indexed: 01/13/2023]
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McClellan SN, Hamilton B, Rettenmaier MA, Lopez K, John CR, Hu JC, Goldstein BH. Individual Physician Experience With Laparoscopic Supracervical Hysterectomy in a Single Outpatient Setting. Surg Innov 2016; 14:102-6. [PMID: 17558015 DOI: 10.1177/1553350607303785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report the surgical experience of a single physician operating at 1 outpatient surgery center using laparoscopic supracervical hysterectomy for the treatment of 100 patients with benign gynecologic disease. Operative status was evaluated in terms of patient morbidity, length of surgery, blood loss, and duration of hospital stay. The mean operative time was 2.6 hours, and the mean anesthesia time was 3.2 hours. The mean estimated blood loss was 116.6 mL, and the mean patient hospital stay was 16.5 hours. There were no reported intraoperative or postoperative complications. Laparoscopic supracervical hysterectomy was not feasible and was converted to laparotomy and total abdominal hysterectomy in 4 patients. The authors present one of the first individual physician experiences at a single outpatient surgery center using laparoscopic supracervical hysterectomy for benign gynecologic conditions. Optimal patient postoperative stay and a minimal complication rate suggest that this procedure performed at a single outpatient surgery center is feasible.
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13
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Maheux-Lacroix S, Lemyre M, Couture V, Bernier G, Laberge PY. Feasibility and safety of outpatient total laparoscopic hysterectomy. JSLS 2016; 19:e2014.00251. [PMID: 25788825 PMCID: PMC4354205 DOI: 10.4293/jsls.2014.00251] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Objective: Ambulatory total laparoscopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be premature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions. Methods: We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center. Results: Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes. Conclusion: Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis.
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Affiliation(s)
- Sarah Maheux-Lacroix
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada
| | - Madeleine Lemyre
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada
| | - Vanessa Couture
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada
| | - Gabrielle Bernier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada
| | - Philippe Y Laberge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada
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14
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Nezhat C, Main J, Paka C, Soliemannjad R, Parsa MA. Advanced gynecologic laparoscopy in a fast-track ambulatory surgery center. JSLS 2016; 18:JSLS-D-13-00291. [PMID: 25392631 PMCID: PMC4154421 DOI: 10.4293/jsls.2014.00291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background/Objectives: It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols. Methods: Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1st 2010 to September 30th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours. Results: One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up. Conclusions: With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.
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Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jillian Main
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Chandhana Paka
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Rose Soliemannjad
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - M Ali Parsa
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
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Bruneau L, Randet M, Evrard S, Damon A, Laurent FX. Prise en charge ambulatoire de l’hystérectomie laparoscopique : évaluation de la faisabilité et de la satisfaction des patientes. ACTA ACUST UNITED AC 2015; 44:870-6. [DOI: 10.1016/j.jgyn.2015.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/18/2015] [Accepted: 02/11/2015] [Indexed: 11/25/2022]
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Penner KR, Fleming ND, Barlavi L, Axtell AE, Lentz SE. Same-day discharge is feasible and safe in patients undergoing minimally invasive staging for gynecologic malignancies. Am J Obstet Gynecol 2015; 212:186.e1-8. [PMID: 25132462 DOI: 10.1016/j.ajog.2014.08.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/13/2014] [Accepted: 08/12/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the feasibility and safety of same-day discharge of patients undergoing minimally invasive comprehensive surgical staging for endometrial and cervical cancer. STUDY DESIGN We performed a retrospective review of consecutive patients from January 2008 to December 2011 undergoing comprehensive staging for endometrial or cervical cancer by traditional laparoscopy or robotic-assisted laparoscopy and intended for same-day discharge. Patients accomplishing same-day discharge were compared with those who required admission. Clinical and demographic data, perioperative outcomes, and postoperative patient contacts within 6 weeks were collected. Multivariate logistic regression modeling was used to determine factors associated with admission and unscheduled patient contacts within 2 weeks of surgery. RESULTS A total of 141 patients were identified. One hundred eighteen patients (83.7%) underwent same-day discharge and 23 (16.3%) required overnight admission. The variables that significantly predicted overnight admission were severe pain in the postanesthesia care unit (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.74-26.6; P = .006), delayed ability to tolerate oral intake (OR, 9.3; 95% CI, 2.25-38.6, P = .002), traditional laparoscopic vs robotic-assisted surgical approach (OR, 9.05; 95% CI, 2.34-35.1; P = .001), and surgery start time at 2:00 pm or later (OR, 36.8; 95% CI, 6.19-219.3; P < .0001). There was no difference in the readmission rate between patients undergoing same-day discharge compared with overnight admission (11% vs 17%, P = .48). No variables significantly predicted unscheduled patient contact within 2 weeks of surgery at P < .01. CONCLUSION Same-day discharge for patients undergoing laparoscopic or robotic-assisted laparoscopic staging for endometrial or cervical cancer is feasible and safe. There are low complication rates and few readmissions or unscheduled patient contacts within 2 weeks of surgery.
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Affiliation(s)
- Kristine R Penner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Irvine Medical Center, Orange, CA
| | - Nicole D Fleming
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Leah Barlavi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Allison E Axtell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Scott E Lentz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
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Abstract
BACKGROUND AND OBJECTIVE Despite the prevalence of hysterectomy for treatment of benign gynecologic conditions, providers nationwide have been slow to adopt minimally-invasive surgical techniques. Our objective is to investigate the impact of a department for minimally invasive gynecologic surgery (MIGS) on the rate of laparoscopic hysterectomy at an academic community hospital without robotic technology. METHODS This retrospective observational study included all patients who underwent hysterectomy for benign indications from January 1, 2004, through December 31, 2012. The primary outcome was route of hysterectomy: open, laparoscopic, or vaginal. Secondary outcomes of interest included length of stay and factors associated with an open procedure. RESULTS In 2004, only 24 (8%) of the 292 hysterectomies performed for benign conditions at Newton-Wellesley Hospital (NWH) were laparoscopic. The rate increased to more than 50% (189/365) by 2008, and, in 2012, 72% (316/439) of hysterectomies were performed via a traditional laparoscopic approach. By 2012, more than 93% (411/439) of all hysterectomies were performed in a minimally invasive manner (including total laparoscopic hysterectomy [TLH], laparoscopic supracervical hysterectomy [LSH], total vaginal hysterectomy [TVH], and laparoscopy-assisted vaginal hysterectomy [LAVH]). More than 85% of the hysterectomies at NWH in 2012 were outpatient procedures. By this time, the surgeon's preference or lack of expertise was rarely cited as a factor leading to open hysterectomy. CONCLUSIONS A large diverse gynecologic surgery department transformed surgical practice from primarily open hysterectomy to a majority (>72%) performed via the traditional laparoscopic route and a large majority (>93%) performed in a minimally invasive manner in less than 8 years, without the use of robotic technology. This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists.
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Affiliation(s)
- Megan Loring
- Center for Minimally Invasive Gynecologic Surgery Newton-Wellesley Hospital, Newton, Massachusetts
| | - Stephanie N Morris
- Center for Minimally Invasive Gynecologic Surgery Newton-Wellesley Hospital, Newton, Massachusetts
| | - Keith B Isaacson
- Center for Minimally Invasive Gynecologic Surgery Newton-Wellesley Hospital, Newton, Massachusetts
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AAGL Practice Report: Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH). J Minim Invasive Gynecol 2014; 21:9-16. [DOI: 10.1016/j.jmig.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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Khavanin N, Mlodinow A, Milad MP, Bilimoria KY, Kim JY. Comparison of Perioperative Outcomes in Outpatient and Inpatient Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2013; 20:604-10. [DOI: 10.1016/j.jmig.2013.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 10/26/2022]
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Nesbitt-Hawes EM, Maley PE, Won HR, Law KS, Zhang CS, Lyons SD, Ledger W, Abbott JA. Laparoscopic Subtotal Hysterectomy: Evidence and Techniques. J Minim Invasive Gynecol 2013; 20:424-34. [DOI: 10.1016/j.jmig.2013.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
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Jacobs VR, Fischer T. A pragmatic guide on how physicians can take over financial control of their clinical practice. JSLS 2013; 16:632-8. [PMID: 23484576 PMCID: PMC3558904 DOI: 10.4293/108680812x13517013316438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Control of clinical cost is becoming increasingly important in health care worldwide. Physicians should accept the limitation of resources and take responsibility to improve their clinical cost-reimbursement ratio. To achieve this, they will need basic education in clinic management to control and adjust costs and reimbursement, without impacting professional quality of care. Rational use of diagnostics and therapy should be implemented and frequently verified. Physicians are the only professionals that are able to integrate economics with health care. This is in the best interest of patients and will improve a physician's position, influence, and professional freedom levels within our hospitals.
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Tuschy B, Berlit S, Sütterlin M, Hornemann A. Duration of hospital stay after gynaecologic laparoscopic surgery: preferences of patients. Arch Gynecol Obstet 2013; 288:335-9. [DOI: 10.1007/s00404-013-2733-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
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LASSEN PERNILLEDANNESKIOLD, MOELLER-LARSEN HEDVIG, DE NULLY PIA. Same-day discharge after laparoscopic hysterectomy. Acta Obstet Gynecol Scand 2012; 91:1339-41. [DOI: 10.1111/j.1600-0412.2012.01535.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cash CL, Frazee RC, Abernathy SW, Childs EW, Davis ML, Hendricks JC, Smith RW. A Prospective Treatment Protocol for Outpatient Laparoscopic Appendectomy for Acute Appendicitis. J Am Coll Surg 2012; 215:101-5; discussion 105-6. [PMID: 22609030 DOI: 10.1016/j.jamcollsurg.2012.02.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/24/2012] [Accepted: 02/24/2012] [Indexed: 11/30/2022]
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Spencer R, Schorge J, Del Carmen M, Goodman A, Growdon W, Boruta D. Laparoscopic Surgery for Endometrial Cancer: Why Don’t All Patients Go Home the Day After Surgery? J Minim Invasive Gynecol 2012; 19:95-100. [DOI: 10.1016/j.jmig.2011.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/13/2011] [Accepted: 10/21/2011] [Indexed: 12/01/2022]
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Abstract
There was no statistically significant difference in pain between laparoscopically assisted vaginal hysterectomy and total laparoscopic hysterectomy during the postoperative period. Background and Objectives: The purpose of this study was to assess the differences in patient pain postoperatively, comparing 2 types of outpatient hysterectomy procedures. Methods: This is a nonblind, nonrandomized, prospective study of surgeries performed at 1 ambulatory surgery center by 1 surgeon over 14 months. Patient pain was assessed using a visual analog scale before and after laparoscopically assisted vaginal hysterectomy and total laparoscopic hysterectomy. Patients were followed through a 2-week postoperative period. Results: Nineteen laparoscopically assisted vaginal hysterectomies and 17 total laparoscopic hysterectomies were performed. The 2 groups were similar in age, BMI, uterine weight, and surgical time. Comparing the 2 groups, there were no statistically significant differences in pain throughout any time points of the study. Conclusion: There were no statistically significant differences in pain during the postoperative period between the 2 groups. Outpatient hysterectomy is a safe procedure that may improve patient satisfaction surgically and financially, and either approach is well tolerated by patients.
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XIROMERITIS P, KALOGIANNIDIS I, PAPADOPOULOS E, PRAPAS N, PRAPAS Y. Improved recovery using multimodal perioperative analgesia in minimally invasive myomectomy: A randomised study. Aust N Z J Obstet Gynaecol 2011; 51:301-6. [DOI: 10.1111/j.1479-828x.2011.01333.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shultz TM. Preemptive multimodal analgesia facilitates same-day discharge following robot-assisted hysterectomy. J Robot Surg 2011; 6:115-23. [PMID: 27628274 DOI: 10.1007/s11701-011-0276-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/09/2011] [Indexed: 12/14/2022]
Abstract
We aimed to determine whether early hospital discharge following minimally invasive surgery can be achieved through the use of preemptive multimodal analgesia without compromising patient safety or comfort. Data were retrospectively collected for 150 patients who underwent robotic-assisted laparoscopic hysterectomy for benign indications from 9 December 2009 to 6 October 2010 at Cox Health Systems (Springfield, MO, USA). One surgeon performed 100 consecutive cases with all patients receiving preemptive multimodal treatment with celecoxib and ropivacaine. These cases were compared with 50 patients treated with an opioid-based postoperative analgesia regimen by one of four other surgeons at the same center. Patient characteristics, perioperative outcomes, opioid requirement, and time to discharge were compared between groups. The patients in the multimodal group had significantly reduced opioid requirements intraoperatively (25.0 mg vs. 29.9 mg, P = 0.0077), postoperatively on the day of surgery (10.9 mg vs. 17.9 mg, P = 0.0030), and on the first postoperative day (3.1 mg vs. 15.3 mg, P = 0.0001). There were no differences in procedure time, transfusions, or readmission rates between groups. Time in the Post-Anesthesia Care Unit (PACU) was decreased in the multimodal group (72.0 min vs. 88.4 min, P < 0.0001), as was time to discharge from the hospital (8.5 h vs. 30.2 h, P < 0.0001). Age and body mass index were both significantly lower in the multimodal group; however, regression analyses demonstrated that analgesia regimen was the only parameter that predicted opioid requirement and time to discharge. Preemptive multimodal analgesia reduced the total dose of rescue opioids, facilitating same-day discharge without compromising patient comfort or safety.
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Affiliation(s)
- Thomas M Shultz
- Primrose OB/GYN, Cox Health Systems, 1000 E. Primrose #270, Springfield, MO, 65807, USA.
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Kisic-Trope J, Qvigstad E, Ballard K. A randomized trial of day-case vs inpatient laparoscopic supracervical hysterectomy. Am J Obstet Gynecol 2011; 204:307.e1-8. [PMID: 21272844 DOI: 10.1016/j.ajog.2010.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 09/21/2010] [Accepted: 11/02/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether women having day-case laparoscopic supracervical hysterectomy are more or less satisfied with the length of hospital stay compared with women who stayed overnight after the procedure. STUDY DESIGN An randomized control trial of 49 women randomized to day-case or overnight hospital stay after laparoscopic supracervical hysterectomy. Satisfaction with length of hospitalization and quality of life were compared using the Mann-Whitney U test. RESULTS No group differences were found in satisfaction with length of hospital stay (P = .13). There was a nonsignificant trend toward greater anxiety in the day-case group (P = .06 on day 1 postoperative). Quality of life was lower in the day-case group on days 2 (P = .02) and 4 (P = .03), postoperatively. CONCLUSION Women having a day-case hysterectomy were discharged after median of 5 hours postoperative and were similarly satisfied as women hospitalized overnight. Quality of life, however, does appear to be compromised by day-case surgery.
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Affiliation(s)
- Jelena Kisic-Trope
- Gynaecology and Endoscopy Unit, Department of Obstetrics and Gynaecology, Oslo University Hospital Ulleval, Oslo, Norway.
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Elective oophorectomy in the United States: trends and in-hospital complications, 1998-2006. Obstet Gynecol 2010; 116:1088-95. [PMID: 20966693 DOI: 10.1097/aog.0b013e3181f5ec9d] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine trends in rates of elective bilateral salpingo-oophorectomy in the United States and to assess the association of perioperative complications with elective bilateral salpingo-oophorectomy. METHODS This cross-sectional study uses 1998-2006 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Analyses were limited to women aged 15 years or older at average risk for ovarian cancer who underwent hysterectomy for a benign gynecologic condition. Tests for trends in elective bilateral salpingo-oophorectomy rates were performed using weighted least squares regression for two time periods, 1998 to 2001 and 2002 to 2006. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risks of complications associated with elective bilateral salpingo-oophorectomy were estimated using logistic regression. RESULTS During the period from 1998 to 2006, 39% of the 2,250,041 women who underwent hysterectomy for benign gynecologic indications had elective bilateral salpingo-oophorectomy (rate, 8.3 per 10,000). The elective bilateral salpingo-oophorectomy rate increased from 7.8 per 10,000 in 1998 to 9.0 per 10,000 in 2001 (P trend <.05) and decreased from 9.0 per 10,000 in 2002 to 7.4 per 10,000 in 2006 (P trend <.05). The largest decline from 2002 to 2006 (20.3%) occurred among those aged 45 to 49 years. Compared with hysterectomy only, elective bilateral salpingo-oophorectomy was associated with an increased risk of complications when performed vaginally (OR 1.12; 95% CI 1.08-1.17) and a decreased risk of complications when performed abdominally (OR 0.91; 95% CI 0.89-0.94) or laparoscopically (OR 0.89; 95% CI 0.83-0.94). CONCLUSION Elective bilateral salpingo-oophorectomy rates declined since 2002. However, the risks compared with the benefits of the procedure have not been clearly established. Prospective studies examining elective bilateral salpingo-oophorectomy with and without estrogen therapy are needed to guide practice patterns. LEVEL OF EVIDENCE III.
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Lowder JL, Oliphant SS, Ghetti C, Burrows LJ, Meyn LA, Balk J. Prophylactic bilateral oophorectomy or removal of remaining ovary at the time of hysterectomy in the United States, 1979-2004. Am J Obstet Gynecol 2010; 202:538.e1-9. [PMID: 20060093 DOI: 10.1016/j.ajog.2009.11.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 09/24/2009] [Accepted: 11/18/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to describe national rates and trends of prophylactic bilateral oophorectomy or remaining oophorectomy (BO/RO) at hysterectomy in women without specific gynecologic disease. STUDY DESIGN Data from the National Hospital Discharge Survey were analyzed for 1979-2004. Hysterectomies were divided into 2 groups: (1) hysterectomy with BO/RO and (2) hysterectomy alone (> or =1 ovary remaining). Age-adjusted rates (AARs) were calculated with 2000 US census data. RESULTS Approximately 3,686,000 hysterectomies with BO/RO were performed from 1979-2004. AARs of hysterectomy with BO/RO decreased during this period; the AARs in women > or =50 years old increased. The number of hysterectomies alone was 5,461,100, and AARs of hysterectomy alone decreased significantly from 2.9 per 1000 women in from 1979-1981 to 1.1 per 1000 women in 2001 (P < .001). The proportion of women who underwent hysterectomy with BO/RO increased from 29% in 1979 to 45% in 2004. CONCLUSION Although AARs of prophylactic BO/RO decreased from 1979-2004, the actual proportion of BO/RO at hysterectomy increased.
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A pilot study to assess the feasibility, safety and cost of robotic assisted total hysterectomy and bilateral salpingo-oophorectomy. J Robot Surg 2010; 4:41-4. [DOI: 10.1007/s11701-010-0183-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
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Comparison of Institutional Costs for Laparoscopic Preperitoneal Inguinal Hernia Versus Open Repair and Its Reimbursement in an Ambulatory Surgery Center. Surg Laparosc Endosc Percutan Tech 2008; 18:70-4. [DOI: 10.1097/sle.0b013e31815a58d7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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de Lapasse C, Rabischong B, Bolandard F, Canis M, Botchorischvili R, Jardon K, Mage G. Total Laparoscopic Hysterectomy and Early Discharge: Satisfaction and Feasibility Study. J Minim Invasive Gynecol 2008; 15:20-5. [DOI: 10.1016/j.jmig.2007.08.608] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 08/08/2007] [Accepted: 08/10/2007] [Indexed: 11/24/2022]
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Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol 2008; 198:34.e1-7. [PMID: 17981254 DOI: 10.1016/j.ajog.2007.05.039] [Citation(s) in RCA: 377] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 04/10/2007] [Accepted: 05/23/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to examine recent trends in hysterectomy rates and indications in the United States. STUDY DESIGN Data on hysterectomy hospitalizations during 2000-2004 were obtained from the National Hospital Discharge Survey, an annual nationally representative survey of inpatient hospitalization records. RESULTS The hysterectomy rate decreased slightly from 5.4 per 1000 in 2000 to 5.1 per 1000 in 2004 (P for trend < .05). The proportion of hysterectomies performed for uterine leiomyoma decreased from 44.2% in 2000 to 38.7% in 2004 (P for trend < .01). Concomitant bilateral oophorectomy accompanied 54% of hysterectomies; this proportion declined from 55.1% in 2000 to 49.5% in 2004 (P for trend < .001). CONCLUSIONS Continued monitoring is needed to determine whether the observed trends persist and to evaluate impact on women's health. In the future, information on both inpatient and outpatient procedures may be important for hysterectomy surveillance.
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Penketh R, Griffiths A, Chawathe S. A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hour day case surgery setting. BJOG 2007; 114:430-6. [PMID: 17378817 DOI: 10.1111/j.1471-0528.2007.01269.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE 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. DESIGN Prospective observational study. SETTING A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology. POPULATION 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. METHOD Prospective observational study. MAIN OUTCOME MEASURES 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- R Penketh
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Heath Park, Cardiff, UK
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Thiel JA, Kamencic H. Assessment of Costs Associated With OutpatientTotal Laparoscopic Hysterectomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:794-798. [PMID: 17022920 DOI: 10.1016/s1701-2163(16)32258-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the costs associated with the performance of outpatient total laparoscopic hysterectomy. METHODS This was a retrospective cohort study involving 224 consecutive patients undergoing total laparoscopic hysterectomy (TLH) by a single surgeon in the Regina General Hospital. Outcomes included costs associated with the initial procedure as well as those associated with any intraoperative or postoperative complications. RESULTS The mean age of the patients was 42.7 years. The mean uterine weight was 205 grams (range 69-1163 g), the mean operating time was 79 minutes, and the mean blood loss was 89 cc. The mean postoperative stay in the day surgery unit (DSU) was 354 minutes. Ten patients required admission from the DSU, and nine patients were admitted more than 24 hours after surgery. The total number of admission days was 24, which cost 21,900 US dollars. The total cost of all disposables was 127,373 US dollars and the cost associated with the stays in day surgery was 89,600 US dollars. The total cost for the 224 TLH procedures was 238,573 US dollars, and the average cost per TLH was 1065 US dollars. CONCLUSION Outpatient TLH can be completed safely and with costs that are lower than those incurred by patients having short-stay vaginal hysterectomy in our institution. Outpatient TLH offers the opportunity to save health care costs and a procedure with excellent results.
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Affiliation(s)
- John A Thiel
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon SK
| | - Huse Kamencic
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon SK
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Herzog TJ, Coleman RL, Guerrieri JP, Gabriel K, Du W, Techner L, Fort JG, Wallin B. A double-blind, randomized, placebo-controlled phase III study of the safety of alvimopan in patients who undergo simple total abdominal hysterectomy. Am J Obstet Gynecol 2006; 195:445-53. [PMID: 16626607 DOI: 10.1016/j.ajog.2006.01.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 12/15/2005] [Accepted: 01/12/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the safety and efficacy of alvimopan, a novel peripherally acting mu-opioid receptor antagonist, in patients who undergo simple total abdominal hysterectomy. STUDY DESIGN Women (n = 519) were randomized (4:1) to receive alvimopan 12 mg (n = 413) or placebo (n = 106) > or = 2 hours before the operation then twice daily for 7 days (hospital and home). Adverse events were monitored up to 30 days after the last dose of study drug was administered. Efficacy was assessed for 7 postoperative days. RESULTS Overall, the most common adverse events were nausea, vomiting, and constipation; < 5% of patients discontinued use because of adverse events. Alvimopan significantly accelerated the time to first bowel movement (hazard ratio, 2.33; P <.001). Average time to first bowel movement was reduced by 22 hours, with more frequent bowel movement and better bowel movement quality found in the treatment cohort. CONCLUSION Alvimopan has a safety profile that is similar to that of placebo and provides significantly improved lower gastrointestinal recovery in women who undergo simple total abdominal hysterectomy.
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