Schedule effect and laparoscopic-assisted vaginal hysterectomy.
BACKGROUND
Prolonged surgical workload and different starting times of laparoscopic-assisted vaginal hysterectomy (LAVH) might be factors influencing surgical and patient's outcomes.


OBJECTIVE
The aim of this study is to elucidate possible detrimental results of the schedule effect on LAVH.


METHODS
Retrospective cohort study based on patient charts and hospital's electronic database in a tertiary teaching hospital. A total of 217 consecutive women who underwent LAVH for gynecological diseases were enrolled. Among them, 159 LAVHs performed by four surgeons were divided into three groups according to three different starting times of the operation. Among 159 LAVHs, 110 performed by the same surgeon were divided into three groups in the same way. Variables related to operative and medical outcomes were compared and analysed by one-way anova and chi-squared test.


RESULTS
Data on both all women (159 cases) and subgroup women (110 cases) revealed that no statistical significant differences among the three groups including length of hospital stay, shift of serum haemoglobin, shift of serum haematocrit, flatulence-relief time, surgical blood loss, blood transfusion rate, rate of postoperative fluid injection over two days after surgery or complication rate. Interestingly, the first LAVH scheduled within the 08.30 to 10.29 hours time slot had the longest mean operation time. LAVHs starting within the 15.30 to 17.29 hours time slot had the shortest mean operation time.


CONCLUSIONS
The time of day in which LAVH is performed does not have a detrimental effect on outcome. Successful LAVH is dependent on multidisciplinary team work to achieve good surgical and patient outcomes.
Department of Obstetrics and Gynaecology, China Medical University and Hospital, Taichung City, Taiwan.
Wei-Chun
WC
Chang
Cheng-Chieh
CC
Lin
Lu-Min
LM
Chen
Hong-Dar Isaac
HD
Wu
Lian-Shung
LS
Yeh
Long-Yau
LY
Lin
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016526:Workload