Laparoscopic Hysterectomy Outcomes: Hospital vs Ambulatory Surgery Center

Abstract

Background and Objective:Compare operative outcomes of laparoscopic hysterectomy in an outpatient hospital setting versus freestanding ambulatory surgery center.Methods:Retrospective cohort study of two groups in an outpatient hospital surgery department and freestanding ambulatory surgical center, both serving the Washington, DC area. Women, 18 years or older, who underwent laparoscopic hysterectomy for benign conditions in an outpatient hospital setting between 2011 and 2014 (n = 821), and at an ambulatory surgery center between 2013 and 2017 (n = 1210). Laparoscopic hysterectomy with retroperitoneal dissection and early ligation of the uterine arteries at the origin, performed by gynecologic surgical specialists from a single practice. Patient characteristics, medical history, uterine weight, pathology, operating times, estimated blood loss, and complications were analyzed.Results:The mean uterine size between settings was not significantly different (Ambulatory Surgery Center, 349.4 g; Hospital, 329.7 g). The largest uteri removed at the surgery center was 3500 g; at the hospital it was 2489 g. The surgery center had a shorter average operating time than the hospital (53.7 and 61.3 minutes, respectively; P < .001). Intraoperative and postoperative complication rates were not significantly different between settings (2.7% and 3.7%, surgery center; 2.1% and 4.8%, hospital). There were two hospital transfers from the surgery center: 1 for blood transfusion, and 1 for low oxygen saturation. Same-day discharge occurred in 99.8% of surgery center patients versus 88% hospital patients.Conclusions:Laparoscopic hysterectomy can be performed safely and effectively by skilled surgeons at a freestanding ambulatory surgery center, even in complex cases with large uteri.

Current Clinical Practice Patterns in Total Vaginal Hysterectomy

“…Although there are no studies specifically addressing TVH at ASCs, it has been shown that complex gynecologic surgery, including TLH, can be safely performed at ASCs. 16,17 It is worth noting that all cohorts cited a lack of access as a reason they do not use ASCs as opposed to discomfort with ASCs for TVH surgery. Geographical location did play a role, with a significantly higher portion of surgeons from the Mid-Atlantic reporting using an ASC.…”

Follow-up Study Comparing Open Hysterectomy of Expert Surgeon and Laparoscopic Approach (Learning Curve) of the Same Surgeon

“…7 An important point is different reports of early years of laparoscopy with longer procedures in comparison to the open method. 20 Three characters are regarded for learning curve assessment including the duration of surgery, rate of complications, and the number of conversions to open surgery. In a study, in the learning curve of laparoscopic hysterectomy, the first 10 procedures were done in a mean time of 180 minutes and decreased to 75 minutes in the 90-100th patients.…”

Seguridad del alta temprana en pacientes con histerectomía laparoscópica en una institución de alto nivel de complejidad en Bogotá, Colombia, 2013 - 2019. Cohorte histórica

“…Con el perfeccionamiento del abordaje mínimamente invasivo, se han publicado estudios que muestran que la vía laparoscópica podría acompañarse de una política de egreso temprano (primeras 12 a 24 horas de la histerectomía) dada la seguridad de este procedimiento. Por ejemplo, MacKoul et al comparan dos instituciones en las que se dio salida temprana, una con manejo ambulatorio con alta temprana en el 98% de las pacientes y otra con hospitalización con salida temprana en 88%, sin diferencia en la frecuencia de complicaciones 7 . Estas observaciones han llevado a un incremento de la frecuencia del alta temprana en pacientes con histerectomía laparoscópica de un 13% en el 2008 a un 57% en el 2014 en centros quirúrgicos ambulatorios de Estados Unidos 8 .…”