Prospective feasability study of ambulatory surgery for pelvic organ prolapse

Christophe Courtieu; Arnaud Cornille; Melanie Vaast; Sandy Lacombe; Laure Panel

doi:10.1016/j.ejogrb.2019.01.019

Prospective feasability study of ambulatory surgery for pelvic organ prolapse

Eur J Obstet Gynecol Reprod Biol. 2019 May:236:36-40. doi: 10.1016/j.ejogrb.2019.01.019. Epub 2019 Mar 5.

Authors

Christophe Courtieu¹, Arnaud Cornille², Melanie Vaast², Sandy Lacombe³, Laure Panel²

Affiliations

¹ Gynecologic Surgery Department, CMC Beau Soleil, Montpellier, France. Electronic address: c.courtieu@languedoc-mutualite.fr.
² Gynecologic Surgery Department, CMC Beau Soleil, Montpellier, France.
³ Clinical Research Department, CMC Beau Soleil, Montpellier, France.

PMID: 30878895
DOI: 10.1016/j.ejogrb.2019.01.019

Abstract

Study objective: The aim of this study was the evaluation of ambulatory surgery (AS) rate for pelvic organ prolapse (POP).

Design: It was a prospective observational study.

Design classification: Level II-2.

Setting: Patients were divided in two groups: Group EAS: patients eligible to ambulatory surgery and Group NEAS: patients not eligible to AS.

Patients: all patients from August 2015 to November 2016 undergoing surgery for POP in our institution.

Measurements: The main outcome was overall AS rate in the population. Secondary outcomes were in NEAS group: reasons for ineligibility; in EAS group: AS success rate, reasons of failure and patient satisfaction related to AS; in each group: post operative re-admission or consultation, morbidity and global satisfaction.

Main results: There was 157patients included in the study. Eligibility criteria for AS was met for 111/157 (707%). Overall AS rate was 58% and success rate of AS was 82%. Reasons for ineligibility to AS were lack of home support (50%), home >1 h from hospital (109%), poor home conditions (2,2%), associated comorbidity (21.7%), associated procedure (4,3%) and refusal for AS (109%). Reasons for failure (20/111, 18%) of AS were unsuccessful trial of void (TOV) (65%), post operative nausea-vomiting (PONV) (15%), sub-cutaneous emphysema (5%), post-operative bleeding (5%) and faulty organization (10%). There was no unscheduled re-admission the night after surgery in EAS group. 7,2% in EAS group and 13% in the NEAS group had an unscheduled consultation. There were 4 re-admissions (3,6%) in the EAS group and 1 (2,2%) in the NEAS group during follow-up. Patient satisfaction to AS was 100% on next-day call and 923% at 6 weeks.

Conclusion: Ambulatory surgery rate was 58% in this population of surgically managed prolapses; AS success rate was 82%. There was no adverse events related to AS and patient satisfaction to AS at 6 weeks is high.

Keywords: Ambulatory surgery; Laparoscopic surgery; Prolapse; Vaginal surgery.

MeSH terms

Aged
Ambulatory Surgical Procedures / statistics & numerical data*
Feasibility Studies
Female
France / epidemiology
Humans
Middle Aged
Pelvic Organ Prolapse / surgery*
Postoperative Complications / epidemiology
Prospective Studies