Hysterectomy: towards an overnight stay

Objective To review the introduction of an overnight stay laparoscopically assisted vaginal hysterectomy (LAVH) service in a district general hospital. Design A retrospective study. Setting Dewsbury District Hospital is a 478-bedded district general hospital with 14 gynaecological inpatient beds, serving a population of 165 000. Data collection Included in the study were 265 consecutive patients who underwent LAVH, performed by one consultant between September 1995 and September 2000. These patients were unsuitable for vaginal hysterectomy according to conventional (British) criteria and in the past would be have been offered abdominal hysterectomy. The names of the patients were obtained from the hospital register. All operative notes were abstracted and data collected independently by junior medical staff working in the department. Results Postoperative stay was analysed for consecutive groups of 50 patients. Initially the median postoperative stay was 2 nights but by the last cohort, nine out of 10 patients were going home after only 1 night’s postoperative stay. None of the patients were readmitted or suffered complications as a result of this policy. Among the patients, 4.5% suffered one or more complications (most were minor). No patient suffered visceral injury. Patients had full surgical recovery by 6 weeks after operation except for a few who developed granulation tissue which needed topical treatment. Conclusion In experienced hands LAVH has few complications, and it is acceptable and safe to discharge patients home after an overnight hospital stay provided strict guidelines are followed. Correspondence A.K. Trehan, Dewsbury District Hospital Halifax Road, Dewsbury, West Yorkshire WF13 4HS, UK.