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 GW-572016 manufacturer [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. (Obstet Gynecol 2012;120:1355-61) DOI: http://10.1097/AOG.0b013e3182732ece”
“OBJECTIVE:
To estimate the incidence of cystoscopy use at time of hysterectomy and its use to detect urinary tract injury.
METHODS: This was a retrospective cohort study in a tertiary care academic KPT-8602 manufacturer center of 1982 patients who underwent a hysterectomy for any indication (excluding obstetric) between January 2009 and December
2010. Medical records were reviewed for baseline and perioperative characteristics, cystoscopy use, and information about bladder or ureteral injury related to hysterectomy.
RESULTS: Two hundred fifty-one women (12.66%, 95% confidence interval [CI] 11.23-14.21%) underwent a cystoscopy at the time of hysterectomy with no reported complications resulting from the cystoscopy procedure. Cystoscopy was most frequently used by low-volume surgeons and in cases involving prolapse or find more vaginal mode of access. Fourteen patients (0.71%, 95% CI 0.39-1.19%) experienced bladder injury and five patients (0.25%, 95% CI 0.08-0.58%) sustained ureteral injury. None of these complications were detected by cystoscopy; cystoscopy was either normal at the time of hysterectomy or was omitted. The presence of adhesions was significantly associated with bladder injury at the time of hysterectomy (P=.006). Low-volume surgeon and laparoscopic or robotic mode of access were both significantly associated with ureteral injury (P=.023 and P=.042, respectively).
CONCLUSIONS: Our data support selective rather than universal cystoscopy at the time of hysterectomy. (Obstet Gynecol 2012;120:1363-70) DOI: http://10.1097/AOG.