Opening of an ambulatory care unit provided an opportunity to evaluate vaginal hysterectomy when performed in a 24-hour day case surgery setting with follow-up telephone support. This prospective observational study enrolled 71 women who underwent vaginal hysterectomy with the intent of discharge within 24 hours after the procedure. All participants had a body mass index less than 40 and a home environment suitable for day case surgery. The most common indications for hysterectomy were dysfunctional uterine bleeding and significant fibroids associated with menorrhagia. Nearly half the hysterectomies were accompanied by oophorectomy. Seven women required laparoscopy in addition to vaginal hysterectomy because of endometriosis or significant adhesions.
A single bladder injury was repaired at the time of surgery; the rate of intraoperative complications was 1.4%. More than 90% of women were discharged home within 24 hours of surgery. Four women who were discharged within 24 hours were readmitted within 10 days with symptoms of mild infection. All of them were managed with oral antibiotics and analgesia on an outpatient basis. The duration of surgery was similar to that found in studies of inpatients, and the same was the case for blood loss and the incidence of febrile illness.
Vaginal hysterectomy appears to be a safe procedure and one that is well accepted by patients when performed as a 24-hour day case procedure. The rate of early discharge exceeded 90% in the present series, and readmission was infrequent. The procedure can be done on most women who ordinarily would be admitted to hospital for abdominal hysterectomy.