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Outpatient Vaginal Hysterectomy: Optimizing Perioperative Management for Same-Day Discharge

OBJECTIVE: To present tactics for optimizing outpatient vaginal hysterectomy and describe perioperative outcomes in a large consecutive case series. METHODS: This is a descriptive study and review of clinical outcomes in 1,071 patients selected to undergo vaginal hysterectomy for benign indications from 2000 to 2010. The setting is a single-surgeon private practice in a community hospital. Outcome measures include length of hospital stay, estimated blood loss, operative time, uterine weight, and perioperative complications, including hospital readmissions and emergency room visits. RESULTS: One thousand seventy-one of 1,162 cases (92%, 95% confidence interval [CI] 90.5–93.7) were total vaginal hysterectomies, of which 1,029 (96%, 95% CI 94.9–97.3) were discharged the same day after surgery. The median operative time was 34 minutes (range 17–210 minutes), and estimated blood loss was 45 mL (range 5–800 mL). The median patient age was 46 years (range 27–86 years), and median uterine weight was 160 g (range 25–1,380 g). One hundred ninety-three patients (18%, 95% CI 15.8–20.5) were nulliparous and 218 (20%, 95% CI 18–22.9) had prior pelvic surgery. Five patients (0.5%, 95% CI 0.2–1.1) required readmission or emergency room evaluation within the first 30 days. CONCLUSION: Vaginal hysterectomy can be successfully adopted as a same-day discharge procedure. In this population, regardless of previous pelvic surgery or nulliparity, good perioperative outcomes have been achieved. LEVEL OF EVIDENCE: III