Day-case Versus Inpatient Laparoscopic Supracervical Hysterectomy

Objective: To determine whether women having day-case laparoscopic supracervical hysterectomy (LSH) are as satisfied with the length of stay in hospital as women who stay overnight following the procedure.

Design: randomised controlled trial (RCT).

Setting: Ulleval university hospital, Oslo, Norway.

Population: 49 women scheduled for LSH were enrolled and 45 patients completed the study (22 in the inpatient group and 23 in the day-case group).

Methods: Women were randomised to either day-case care or overnight hospital stay following a routine supracervical hysterectomy. The primary outcome measure was satisfaction with the length of stay in the hospital (measured on a 10-point visual analogue scale) and secondary measures were health-related quality of life (measured using the EuroQol EQ5D), anxiety (measured using the State-Trait Anxiety Inventory for Adults (STAI) and general questions about their experiences of having the operation. Readmissions, prolonged hospitalisations, complications and any contact with a health professional after discharge were also recorded. Measures were taken on the day of surgery (postoperatively), and on days 1, 2, 4 and 7 following surgery. The data were analysed based on an intention to treat.

Inclusion criteria

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• women requiring a hysterectomy for benign conditions

Exclusion criteria

• previous history of cervical dysplasia, an abnormal smear test within the last two to three years,
• abnormal histology or cytology at endometrial sampling,
• a history of endometriosis,
• advanced endometriosis diagnosed intra-operatively,
• previous major abdominal or pelvic surgery (patients with previous caesarean section were considered as eligible),
• a mental disorder or somatic disease that would interfere with a normal recovery pattern such as substance dependence disorder,
• psychosis, or American Society of Anaesthesiologists (ASA) rating 3 and 4 patients, and
• inability to understand and execute oral and written Norwegian language.
• women were also excluded from the study if they did not have an adult carer (a relative or a friend) staying with them during the first night after discharge; or they were living or staying at a hotel more than an hour's drive from the hospital; and if they did not have access to a telephone.