Fast track vaginal surgery.
OBJECTIVE
Our aim was to describe the need for postoperative hospitalization after vaginal surgery for utero-vaginal prolapse with well-defined charts for postoperative care.


METHODS
A prospective, descriptive study. Consecutive women admitted for first-time vaginal surgery for utero-vaginal prolapse at a public university hospital in Copenhagen, Denmark, underwent surgery and postoperative care in a fast track setting from September 15, 1999 to June 15 2000.


METHODS
A multimodal rehabilitation model with emphasis on information, standardized general anesthesia, reduced surgical distress, optimized pain-relief, early oral nutrition and ambulation, minimal use of indwelling catheter and vaginal packing.


METHODS
Postoperative hospital stay, complications, re-admission, success rate, patients' satisfaction and acceptability.


RESULTS
Forty-one women with a median age of 69 years (range, 44-88 years) were included. All underwent anterior and/or posterior vaginal repair. Nineteen (46.3%) underwent vaginal hysterectomy, and eight (19.5%) underwent the Manchester procedure. Postoperative hospital stay was median 24 hr. Only three (7.3%) were discharged later than 48 hr. No re-admissions occurred. The most frequent complications were urinary retention exceeding 450 ml, and urinary tract infection (12.2%, and 9.8%, respectively). Short-term success rate was 97.6%. Patients' satisfaction rates were 85.4-95.1%. The median score of acceptability was 10 on a 0-10 points scale.


CONCLUSIONS
The need for postoperative hospitalization was median 24 hr after vaginal surgery in a fast track setting, independently of the complexity of the procedure performed. Short-term success rate, satisfaction rates, and acceptability were all excellent. Follow up has been established to evaluate long-term success rates and recurrence.
Ottesen
Marianne
M
Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark.
Sørensen
Mette
M
Rasmussen
Yvonne
Y
Smidt-Jensen
Steen
S
Kehlet
Henrik
H
Ottesen
Bent
B
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D007431:Intraoperative Complications / Q000628:therapy; D007902:Length of Stay / Q000639:trends*; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy*; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*