Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 1

An Audit Of

GYNAECOLOGICAL AMBULATORY SURGERY

Nova Medical Centers, Koramangala

1ST Jun 2009 - 30th Jun 2011

Dr Jaya Bhat MD DGO FRCOG

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 2

Overview of Gynecology Cases

Gynecology Cases

No. of Surgeries

Total 461

Personal Series

319

Others 142

Personal Series,

319

Others, 142

Total Gynecology cases :461

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 3

Major surgeries : 31/319

Major Surgeries Number : 31

Vaginal

Hysterectomy

17

Total Abdominal

Hysterectomy

11

LAVH 1

Myomectomy 2

17

11

2 1

Total Major Surgeries - 31)

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 4

Other surgeries :258/319

101

62 58

29 25

6 3 1 1 1 1 1

Other Gynaecology (258) Other Surgeries Number of

Cases

Laparoscopy 101

D&C 62

Hysteroscopy 58

MTP 29

Suction & Evacuation

25

Mirena Insertion 6

Cervical Encirclage 3

IUCD Removal 1

Cervical Cautery 1

Cervical biopsy 1

Bartholin’s Abscess 1

Anterior Colporraphy

1

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 5

Duration of Hospital Stay

Type of Surgery

Duration of Stay

Majors 2 nights

Others Same day discharge

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 6

Complications - 2

Case 1

Abdominal Distension

Shifted to Major Hospital

CT Scan / Normal

Settled

Case 2

Suspected Vascular Injury

Laparotomy

No Major Injuries

No Problems

Ambulatory Gynecology Surgery

Our Results

• Patients Satisfied

• Good Pain Relief

• No PONV

• Ambulatory Surgery Effective

September 3, 2011, Bangalore Jaya Bhat 7

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 8 September 3, 2011, Bangalore Jaya Bhat 8 8

Randomized Trial of

Day Care Vs Inpatient

Laparoscopic Supra cervical Hysterectomy

Randomized – 49

Literature Survey -Study 1

Day Care – 24 In patient – 25

Jelene Kisic Trop et al; AJOG 2011: 204:307-308

Objective of the Study • Satisfaction with length of hospitalv Stay • Quality of Life

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 9

Literature Survey -Study 1 - Results

• Women having inpatient surgery were more satisfied than those having a day care procedure. Not Statistically Significant • Quality of life Lower and Anxiety Higher in day care group • After 2-4 days both groups were equally satisfied • There is need for individual choice

Ambulatory Gynecology Surgery

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Literature Survey -Study 2

Day Surgery for Gynaecology Laparoscopy Clinical Results for an RCT.

Claire Gudex et al: J Ambulatory Surgery;12(2006):151-157

Objective

To compare clinical outcome from inpatient

and ambulatory laparoscopy for benign gynecological condition

26 (Inpatient ) Vs 40 Ambulatory

PONV and after hospital discharge - Same

Outcome after one month – Same

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 11

• ICD Coding • Protocols • Registry

Our Goal: to Introduce

Ambulatory Gynecology Surgery

September 3, 2011, Bangalore Jaya Bhat 12

Thank You