NCT01556204.

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To determine the safety and feasibility of same-day discharge (SDD) in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. Design: Prospective cohort pilot study. Setting: Single academic medical center. Patients: Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. Interventions: SDD or overnight hospitalization after surgery. Measurements and Main Results: A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women who were planned for overnight hospitalization. The intervention group had 36 women who were planned for SDD. In the intervention group 63.9% of patients (n = 23) were successfully discharged home and 36.1% (n = 13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness, n = 9, 69%), uncontrolled pain (n = 1, 7.7%), fever (n = 1, 7.7%), anemia (n = 2, 15.4%), with return to operating room for hematoma evacuation (n = 1, 7.7%). A voiding trial was passed on the first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (p = .011). There were no significant differences in the number of emergency department visits (p = .677) or unplanned office visits (p = .193) between the control and intervention groups. Conclusion: SDD after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same day did not require a higher volume of emergency department or office evaluations.

To identify risk factors associated with postoperative urinary retention in patients undergoing outpatient minimally invasive hysterectomy. Design: A retrospective cohort study. Setting: An academic medical center. Patients: All patients undergoing outpatient minimally invasive hysterectomy between January 2013 and July 2018 were considered for inclusion in the study. Interventions: Outpatient laparoscopic, vaginal, or robotically assisted laparoscopic hysterectomy. Measurements and Main Results: Four hundred forty-four patients met the inclusion criteria. Postoperative urinary retention occurred in 94 patients, and 347 patients successfully passed their voiding trial in the postanesthesia care unit for a pass rate of 79%. Demographic characteristics were similar, except patients who experienced postoperative urinary retention were less likely to be menopausal (23.4% vs 34.7%, p = .038). Those with urinary retention received more perioperative opioids (morphine milligram equivalent of 14.4 mg vs11.2 mg, p = .012), had longer operative times (122.9 § 55.6 vs 95.7 § 42.3 minutes, p < .01), and experienced more blood loss (105.3 § 134.4 vs 78.5 § 86.8 mL, p = .025). The rate of urinary tract infections was similar. Logistic regression analysis showed that the route of hysterectomy and age were not associated with an increased risk for urinary retention, whereas a longer operative time and higher doses of perioperative opioid use were. Conclusion:In patients undergoing minimally invasive outpatient hysterectomy, a longer operative time and increased perioperative narcotic use increases the risk of postoperative urinary retention.

Among this cohort, all cases of unsuspected UM at the time of myomectomy or hysterectomy using power morcellation were found to be endometrial carcinoma. Unsuspected UM pathology had an incidence of 1 of 502. Factors associated with increased likelihood of UM or UPM were greater uterine weight and leiomyoma as the surgical indication.

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Study Objective: To assess hormone replacement therapy (HRT) prescription pattern in patients undergoing premature surgical menopause on the basis of surgical indication. Design: Retrospective cohort study. Setting: Academic tertiary care center. Patients: Surgically menopausal patients aged ≤45 years who underwent a minimally invasive hysterectomy with salpingooophorectomy. Interventions: HRT prescription in the 6-week postoperative period. Measurements and Main Results: A total of 63 patients met inclusion criteria. Of these, 52% (n = 33) were prescribed HRT in the 6-week postoperative period. Indications for surgical menopause included pelvic pain or endometriosis (31.7%), gynecologic malignancy (20.6%), BRCA gene mutation (17.4%), breast cancer (9.5%), Lynch syndrome (4.8%), and other (15.8%). In total, 80% of patients with pelvic pain, 25% with gynecologic malignancies, 45% with BRCA gene mutations, 33.3% with breast cancer, and 66.6% with Lynch syndrome used HRT postoperatively. In patients who used HRT postoperatively, 76% were offered preoperative HRT counseling. This is in contrast with those patients who did not use HRT postoperatively, of whom only 33% were offered HRT counseling (p <.001). Perioperative complications were not predictive of HRT use postoperatively. In patients who did not use HRT postoperatively, 13.3% used alternative nonhormonal therapy. Conclusion: In patients who underwent premature surgical menopause, 52% used HRT postoperatively. Patients with pelvic pain and Lynch syndrome were more likely to use HRT, whereas those with gynecologic or breast malignancies and BRCA gene mutations were less likely to use HRT. Preoperative HRT counseling was associated with postoperative HRT use.

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