Outpatient vaginal hysterectomy is safe for patients and reduces institutional cost.
OBJECTIVE
To evaluate a management protocol based on scientific evidence in the care of patients undergoing vaginal hysterectomy.


METHODS
(Canadian Task Force classification II-2).


METHODS
110-bed community hospital.


METHODS
Women with vaginal hysterectomy between 2000 and 2003.


METHODS
Data were collected on all vaginal hysterectomies performed by a single surgeon over a 4-year period. Demographics, surgical indications, procedural parameters, length of stay, and postoperative complications were evaluated. Hospital costs for all vaginal hysterectomies performed over a 2-year period at the same hospital also were examined. An analysis of the literature was performed to develop a protocol for optimizing patients' surgical experience. All patients were managed using the protocol. These patients were compared with a cohort at the same institution.


RESULTS
Four hundred twelve vaginal hysterectomies were performed by the lead author during the 4-year time period. Three hundred eighty-four patients (93%) were discharged within 12 hours of admission. There were no readmissions for bleeding, pain management, urinary retention, or nausea and vomiting. Four hundred nineteen vaginal hysterectomies were performed by 10 surgeons from 2002 through 2003 at the same institution, including 219 by the lead author. The average direct cost for outpatient vaginal hysterectomy was 21.3% lower than for inpatient vaginal hysterectomy.


CONCLUSIONS
Incorporating a protocol based on scientific evidence into the management of surgical patients facilitated safe outpatient vaginal hysterectomy in a majority of patients. This optimized management may save up to 25% of the cost for these procedures.
Levy
Barbara S
BS
Women's Health Center, St. Francis Hospital, Federal Way, Washington 98003, and University of Colorado Health Sciences Center, Denver, USA. drbarblevy@aol.com
Luciano
Danielle E
DE
Emery
Laura L
LL
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies