Researchers at Kaiser Permanente Northern California (Oakland, USA) conducted a retrospective case series of 1,015 women discharged home after total or supracervical laparoscopic hysterectomy in a managed care setting, over a three period. Chart reviews were performed for outcomes of interest, which included readmission rates, emergency visits, and surgical and demographic characteristics. The two hysterectomy groups were compared using χ2 tests for categorical variables and t-tests or Wilcoxon rank-sum tests for continuously measured variables.
The results showed that 527 patients (52%) were discharged home the same-day; of those, 46% had total laparoscopic hysterectomies and 54% had supracervical hysterectomies. Cumulative readmission rates were 0.6%, 3.6%, and 4.0% at 48 hours, 3 months, and 12 months, respectively. The most common readmission diagnoses included abdominal incision infection, cuff dehiscence, and vaginal bleeding. Less than 4% of patients presented for emergency care within 48 or 72 hours, most commonly for nausea or vomiting, pain, and urinary retention. There was no difference in readmission rates or emergency visits for the total compared with the supracervical laparoscopic hysterectomy group. The study was published in the May 2011 issue of Obstetrics & Gynecology.
"There was a time when it was considered unusual to send an uncomplicated laparoscopic cholecystectomy home the same day, and now it is standard practice," said lead author Eve Zaritsky, MD. "This study provides evidence that women do not necessarily need to stay in the hospital and thus can enjoy the quiet and comfort of their own home."
Hysterectomy, the surgical removal of the uterus, may be total, involving the removal of the body, fundus, and cervix of the uterus, or supracervical, involving the removal of the uterine body while leaving the cervix intact. It is the most commonly performed gynecological surgical procedure, with over 600,000 hysterectomies performed annually in the United States alone, 90% of which were performed for benign conditions. Such rates, the highest in the industrialized world, has led to a major controversy claiming that hysterectomies are being largely performed for unwarranted and unnecessary reasons.
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