title: Hospital recovery following Thermachoice ablation is not dependent on setting (outpatient or daycase) or rescue analgesia: unexpected result.
abstract: BACKGROUND
  Thermal balloon endometrial ablation (TBEA) is increasingly being performed in the outpatient setting under local anaesthesia (LA) rather than in a daycase setting under general anaesthesia (GA). Our aim was to compare the post operative rescue analgesia requirements and duration of hospital stay in women undergoing outpatient (LA) and daycase (GA) TBEA.
  
  
  METHODS
  Prospective observational study of consecutively recruited women who underwent outpatient (LA) TBEA (n=51) and daycase (GA) TBEA (n=50) over the same time period. Analgesia that was provided additional to the standard administered analgesic regimen was considered rescue analgesia. The main outcome measures were requirement for rescue analgesia and duration of hospital stay in both cohorts.
  
  
  RESULTS
  LA compared to GA cohorts had shorter hospital stays (11 h [95% CI 9-13] vs. 17 h [95% CI 14-20]) and lower analgesia requirements. However, multivariate regression, correcting for all known confounders, showed that duration of stay was independent of setting for ablation or amount of rescue analgesia.
  
  
  CONCLUSIONS
  Duration of hospital stay is not entirely dependent on whether outpatient or daycase endometrial ablation is considered. This unexpected preliminary finding deserves to be validated in future confirmatory trials that compare outpatient and daycase treatments. We also discuss the confounding factors that should be considered when designing such trials.
authors.affiliation: Guy's and St.Thomas' NHS Foundation Trust, Department of Women's Health, 10th floor, North Wing, St.Thomas' Hospital, London SE1 7EH, United Kingdom. rajeshvarma@blueyonder.co.uk
authors.forename: Rajesh
authors.initials: R
authors.lastname: Varma
authors.forename: Hemi
authors.initials: H
authors.lastname: Soneja
authors.forename: Nadia
authors.initials: N
authors.lastname: Samuel
authors.forename: Eki
authors.initials: E
authors.lastname: Sangha
authors.forename: T Justin
authors.initials: TJ
authors.lastname: Clark
authors.forename: Janesh K
authors.initials: JK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000772:Anesthesia, Local; D002404:Catheterization; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008595:Menorrhagia / Q000628:therapy*; D008875:Middle Aged; D010045:Outpatients; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011446:Prospective Studies