title: Home within 24 hours of laparoscopic hysterectomy.
abstract: We assessed the feasibility of safe discharge home within 24 hours following laparoscopic hysterectomy in 30 patients who met the inclusion criteria and consented to be enrolled in the study group. Patients were admitted on the day of their surgery with the expectation of discharge within 24 hours. Appropriate home nursing follow-up and phone contact by the surgical team were organized preoperatively. Inclusion criteria were: age 30-65 years, absence of any major medical history that would require prolonged hospitalization, availability of home support for the first 48 hours after discharge and presence of a working telephone line and an address within the area of the Community Home Nursing service. All 30 operative procedures were completed without incident. Six patients underwent total laparoscopic hysterectomy (TLH) (all the procedures of hysterectomy being performed laparoscopically including the suturing of uterine arteries, colpotomy and closure of the vaginal vault. The uterus was removed vaginally) and 24 patients underwent laparoscopic hysterectomy (LH) (this techniques differs from TLH in that the colpotomy was performed laparoscopically but the uterosacral ligaments were divided vaginally and the vault also was closed vaginally after the uterus was removed vaginally). The average operating time was 115 minutes (range 85-150 minutes) and the average blood loss was 97 mL (20-250 mL). There were no intraoperative complications, no requirement for transfusion and no readmission to hospital for any of the patients in the study. Postoperative complications were minor (umbilical cellulitis (1), intestinal colic (1)) and both were treated with resolution of the symptoms. Ninety per cent of patients in the study were discharged within 24 hours of their surgery, the average duration of stay being 22.9 hours (20-24 hours). Three patients were not fit for discharge at 24 hours postoperatively due to general lethargy, migraine and nausea; their average discharge time was 53.5 hours. The study showed that laparoscopic hysterectomy can be associated with a reduction in length of in-patient stay compared to traditional laparotomy. Furthermore this reduction could be safely reduced to 24 hours following laparoscopic hysterectomy. There was also an associated cost saving in terms of inpatient bed days. Patient satisfaction with this protocol was high in this selected and motivated group.
authors.affiliation: Sydney Women's Endosurgery Centre and Department of Obstetrics and Gynaecology, St George Hospital, Kogarah, New South Wales, Australia.
authors.forename: D C
authors.initials: DC
authors.lastname: Chou
authors.forename: D M
authors.initials: DM
authors.lastname: Rosen
authors.forename: G M
authors.initials: GM
authors.lastname: Cario
authors.forename: M A
authors.initials: MA
authors.lastname: Carlton
authors.forename: A M
authors.initials: AM
authors.lastname: Lam
authors.forename: M
authors.initials: M
authors.lastname: Chapman
authors.forename: C
authors.initials: C
authors.lastname: Johns
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D009517:New South Wales