AMeTHYST (AMbulatory HYsterectomy surgery). Feasibility of minimally invasive outpatient hysterectomy, a preliminary study

Dolivet, Enora; Foulon, Arthur; Simonet, Thérèse; Sanguin, Sophie; Turck, M.; Pizzoferrato, Anne‐Cécile; Fauvet, R.

doi:10.1016/j.ejogrb.2020.07.019

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…In England, the mean rate of emergency readmission within 30 days of laparoscopic hysterectomies is 4.9% ( Meulen et al, 2018 ). Our findings are in keeping with previous observational series from the USA and Europe examining the feasibility of same-day TLH reported success rate of 41.7% to 97% with readmission rate ranging from 1.4% to 8%, and up to 6% return to theatre in the first 30 days following the procedure ( Doliyet et al, 2020 ; Thiel and Gamelin, 2003 ; Rivard et al, 2015 ; Summitt et al, 1992 ; Alperin et al, 2012 ). Furthermore, there was 20% of patients requiring prolonged hospitalisation ( Doliyet et al, 2020 ), and 3.4% rate of conversion to laparotomy ( Alperin et al, 2012 ).…”

Section: Discussionsupporting

confidence: 92%

“…Our findings are in keeping with previous observational series from the USA and Europe examining the feasibility of same-day TLH reported success rate of 41.7% to 97% with readmission rate ranging from 1.4% to 8%, and up to 6% return to theatre in the first 30 days following the procedure ( Doliyet et al, 2020 ; Thiel and Gamelin, 2003 ; Rivard et al, 2015 ; Summitt et al, 1992 ; Alperin et al, 2012 ). Furthermore, there was 20% of patients requiring prolonged hospitalisation ( Doliyet et al, 2020 ), and 3.4% rate of conversion to laparotomy ( Alperin et al, 2012 ). Data from a recent, large, multicentre RCT in the UK ( Cooper et al, 2019 ) comparing laparoscopic supracervical hysterectomy and endometrial ablation, showed that post- operative hospital stay was less than 24 hours in 68% of women who were randomly allocated to laparoscopic supracervical hysterectomy, this may reflect the lack of a structured model as set out and assessed in our study.…”

Section: Discussionsupporting

confidence: 92%

“…In the context of same-day discharge following TLH, a recent RCT demonstrated that voiding within 6 hours after surgery was associated with a successful same-day discharge (Sandberg et al, 2019). The main reasons given for prolonged stay in other observational studies were pain, nausea and vomiting (Dindo et al, 2004;Jennings et al, 2015;Bruneau et al, 2015;Dolivet et al, 2020). In our study, less than 3% of women had prolonged stay due to urinary retention or excessive pain, with nausea and vomiting not recorded as a prime reason for protracted admission.…”

Section: Discussionmentioning

confidence: 99%

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Short stay laparoscopic hysterectomy: An evaluation of feasibility and patient satisfaction

Antoun¹,

Smith²,

Afifi³

et al. 2021

Facts Views Vis ObGyn

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Background: Short-stay total laparoscopic hysterectomy (TLH) could lead to reduced hospital costs and decrease complications associated with hospitalisation such as hospital acquired-infection and venous thromboembolism. Objective: To evaluate the feasibility, safety and patient satisfaction of a novel short ‘less than 23-hour’ stay TLH protocol. Material and Methods: Prospective cohort study, at Birmingham Women’s Hospital, United Kingdom including eligible women undergoing TLH for benign indications or early stage cervical/endometrial cancer. Main outcome measures: Feasibility of discharge within 23-hours following TLH. Surgical complications and readmission rates were collected within 30-days of hysterectomy and patient’s satisfaction was assessed at 6-weeks. Results: Of the 128 eligible women, 104/128 women (81%) were discharged within 23-hours of admission, of which 62/104 or 60% (48.4% of the whole cohort) were discharged on the same day. Adenomyosis/fibroids, and previous caesarean sections were associated with a greater likelihood of stay beyond 23-hours (P<0.05). The overall complications rate was 13/128 (10%) with two grade-3 Clavien-Dindo intraoperative complications; one serosal bowel injury oversewn and one ureteric injury requiring reimplantation. The readmissions rate was 5/128 (4%). 94% of patients were ‘happy’ or ‘very happy’ with the pathway, although satisfaction was higher in short-stay patients (RR 1.2; 95% CI 0.95–1.94). Conclusion: Hospital discharge within 23-hours of TLH appears to be safe, feasible and acceptable to patients where a standardised, multidisciplinary care protocol is used. What is new? Our study is the first prospective case series in the UK reporting the safety and acceptability for performing laparoscopic hysterectomy as a 23-hour day case procedure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short stay laparoscopic hysterectomy: An evaluation of feasibility and patient satisfaction

Antoun¹,

Smith²,

Afifi³

et al. 2021

Facts Views Vis ObGyn

View full text Add to dashboard Cite

show abstract

“…[3][4][5] When assessing pre-operative factors contributing to the success of day case hysterectomies, surgeon experience, operating time and surgical technique were the most significant factors, with patient factors of younger age, lower body mass index and reduced co-morbidity score resulting in higher discharge rates. 6,7 Barriers to discharge identified in literature include pain, postoperative nausea and vomiting 8 and urinary retention, which were more likely with longer operating time, more blood loss and more intra-operative opioid use. 9 Same-day discharge rates vary considerably between previous studies: from 40.3% in a large systematic review including over 140 000 patients, 10 to 99.8% in some American units performing TLH in outpatient clinics.…”

Section: Introductionmentioning

confidence: 99%

Introduction of the day case total laparoscopic hysterectomy (TLH) protocol

Byford

Madhok

Baldan

et al. 2022

Aust NZ J Obst Gynaeco

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Background Traditionally total laparoscopic hysterectomy (TLH) patients are admitted for 1–2 days post‐operatively. Day case TLH has been proven to be feasible and safe in other countries; however, this tertiary Queensland hospital is one of the first Australian institutions to introduce a day case TLH protocol. Aim To pilot the implementation of our day case TLH protocol assessing the feasibility, safety and patient satisfaction of same‐day discharge. Materials and Methods A retrospective audit of the implementation of our day case TLH protocol at a tertiary Queensland hospital was conducted. Primary outcome was length of post‐operative hospital stay. Secondary outcomes included perioperative complications and post‐operative re‐presentation rates. Patient satisfaction was assessed through a patient questionnaire. Results Seventy‐seven patients were included in the study. There were 94.81% patients who went home on the same day. Their average length of post‐operative hospital stay was 7.72 (SD ± 3.36) hours. Of the patients who did achieve same‐day discharge, the average length of stay was 7.05 (SD ±1.46) hours. There were no significant differences in perioperative complications or re‐presentation rates compared to previously published literature. Patients reported they were extremely satisfied with day case TLH. Conclusion The implementation of our day case TLH protocol is feasible, safe and well received by patients in our tertiary Australian hospital. These results can have multimodal effects in healthcare: decrease in hospital costs by reducing length of stay and overnight admissions, improved theatre efficiency and patient flow, while maintaining patient safety and satisfaction.

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“…The main obstacles to performing "same day discharge hysterectomy" are postoperative pain, medico-social habits and administrative constraints. 5 Preceding this study standard of care at our institution after laparoscopic hysterectomy was inpatient stay for 24+ hours after surgery. This implementation was due to safety protocols and difficulties in transportation to the hospital.…”

mentioning

confidence: 99%

Early Discharge After Laparoscopic Hysterectomy: Six Month Trial of Outcomes and Complications

ÇETİN¹,

KARASU²,

TANOĞLU³

et al. 2022

TJRMS

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The gynecologic patient benefits from early discharge in many ways. A growing evidence of literature suggests that same-day discharge is safe for minimally invasive hysterectomy for benign indications.The primary outcome was the acceptability rate of early discharge after informing patients that if they wish they can be discharged from the hospital within 24 hours or they might stay longer. The secondary outcomes were to evaluate the 30 day emergency department and hospital readmission rates between same-day discharge and delayed discharge after laparoscopic hysterectomy in an academic referral centre. Material and Methods: This is an observational non-randomised prospective clinical trial. Patients who underwent laparoscopic hysterectomy at an hospital deemed "fit for discharge" were evaluated. Variables including patient comorbidities and other details were prospectively collected for each patient. Postoperative outcomes were followed for 30 days following the operation utilizing the hospital's central medical record system.All patients were scheduled for postoperative 1 month control to account for any other hospital visits or admissions besides our centre. Results: From October 2021 to April 2022, a total of 275 laparoscopic hysterectomies were performed at our department. After exclusion criteria 194 patients were deemed fit for discharge using a check-list. 96 (49.5 %) of these preffered to be discharged before 24 hours while the slight majority of 98 patients (50.5 %) opted to stay over 24 hours. The groups were similar with regards to age, BMI, clinical and surgical characteristics. The only effective variable reaching statistical significance between the two groups was the duration of the operation. Our readmisson rate was 1.04 % in the early discharge group and 1.02 % in the late discharge group. Conclusion: Duration of surgery was the sole variable effecting patient preference of early discharge. There was no difference in complications or 30-day emergency department visits in either group. Even though it was considered safe to be early discharged to home, as evident by low complication and readmission rates, more than half of our patients did not prefer to do so. Promoting nursing staff and home based visits may increase the acceptability of early discharge.

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AMeTHYST (AMbulatory HYsterectomy surgery). Feasibility of minimally invasive outpatient hysterectomy, a preliminary study

Cited by 6 publications

References 16 publications

Short stay laparoscopic hysterectomy: An evaluation of feasibility and patient satisfaction

Short stay laparoscopic hysterectomy: An evaluation of feasibility and patient satisfaction

Introduction of the day case total laparoscopic hysterectomy (TLH) protocol

Early Discharge After Laparoscopic Hysterectomy: Six Month Trial of Outcomes and Complications

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