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Ambulatory Gynecology Surgery




                                          An Audit Of
                                       GYNAECOLOGICAL
                                     AMBULATORY SURGERY

                    Nova Medical Centers, Koramangala
                                     1ST Jun 2009 - 30th Jun 2011
                                          Dr Jaya Bhat
                                            MD DGO FRCOG




      September 3, 2011, Bangalore              Jaya Bhat           1
Ambulatory Gynecology Surgery



                          Overview of Gynecology Cases
                      Total Gynecology cases :461

                                                         Gynecology  No. of
                                                           Cases    Surgeries
                                                         Total         461
                      Others,
                       142
                                                         Personal      319
                                                         Series
                                                         Others        142

                                          Personal
                                           Series,
                                            319




         September 3, 2011, Bangalore        Jaya Bhat                          2
Ambulatory Gynecology Surgery



                       Major surgeries : 31/319
                 Total Major Surgeries - 31)                   Major Surgeries   Number : 31

                       17                                      Vaginal               17
                                                               Hysterectomy
                                  11                           Total Abdominal       11
                                                               Hysterectomy
                                                               LAVH                   1
                                       2
                                               1               Myomectomy             2




   September 3, 2011, Bangalore                                                                3
                                                   Jaya Bhat
Ambulatory Gynecology Surgery


                        Other surgeries :258/319
      Other Surgeries           Number of
                                                       Other Gynaecology (258)
                                  Cases
      Laparoscopy            101
                                            101
      D&C                    62
      Hysteroscopy           58
      MTP                    29
      Suction &              25                   62
      Evacuation                                       58

      Mirena Insertion       6
      Cervical Encirclage    3
                                                            29
                                                                 25

      IUCD Removal           1
                                                                      6
      Cervical Cautery       1                                            3   1   1   1   1   1
      Cervical biopsy        1
      Bartholin’s Abscess    1


      Anterior               1
      Colporraphy
      September 3, 2011, Bangalore            Jaya Bhat                                           4
Ambulatory Gynecology Surgery



                     Duration of Hospital Stay


        Type of Duration
        Surgery of Stay
        Majors  2 nights
        Others           Same day
                         discharge




      September 3, 2011, Bangalore   Jaya Bhat   5
Ambulatory Gynecology Surgery




                                Complications - 2


                  Case 1                              Case 2
            Abdominal                           Suspected Vascular
            Distension                          Injury
            Shifted to Major
                                                Laparotomy
            Hospital
            CT Scan / Normal                    No Major Injuries
            Settled                             No Problems


      September 3, 2011, Bangalore       Jaya Bhat                   6
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



                           Literature Survey -Study 1
                          Randomized Trial of
                         Day Care Vs Inpatient
                Laparoscopic Supra cervical Hysterectomy
                             Jelene Kisic Trop et al; AJOG 2011: 204:307-308

                                        Randomized – 49

                  In patient – 25                                 Day Care – 24


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

      September 3, 2011, Bangalore
            8                                     Jaya Bhat                       8
Ambulatory Gynecology Surgery



                  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


      September 3, 2011, Bangalore   Jaya Bhat                       9
Ambulatory Gynecology Surgery



                                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

      September 3, 2011, Bangalore
            10                                   Jaya Bhat                            10
Ambulatory Gynecology Surgery




                          Our Goal: to Introduce

                                     • ICD Coding
                                     • Protocols
                                     • Registry




      September 3, 2011, Bangalore         Jaya Bhat   11
Ambulatory Gynecology Surgery




                                     Thank You



      September 3, 2011, Bangalore       Jaya Bhat   12

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  • 1. Ambulatory Gynecology Surgery An Audit Of GYNAECOLOGICAL AMBULATORY SURGERY Nova Medical Centers, Koramangala 1ST Jun 2009 - 30th Jun 2011 Dr Jaya Bhat MD DGO FRCOG September 3, 2011, Bangalore Jaya Bhat 1
  • 2. Ambulatory Gynecology Surgery Overview of Gynecology Cases Total Gynecology cases :461 Gynecology No. of Cases Surgeries Total 461 Others, 142 Personal 319 Series Others 142 Personal Series, 319 September 3, 2011, Bangalore Jaya Bhat 2
  • 3. Ambulatory Gynecology Surgery Major surgeries : 31/319 Total Major Surgeries - 31) Major Surgeries Number : 31 17 Vaginal 17 Hysterectomy 11 Total Abdominal 11 Hysterectomy LAVH 1 2 1 Myomectomy 2 September 3, 2011, Bangalore 3 Jaya Bhat
  • 4. Ambulatory Gynecology Surgery Other surgeries :258/319 Other Surgeries Number of Other Gynaecology (258) Cases Laparoscopy 101 101 D&C 62 Hysteroscopy 58 MTP 29 Suction & 25 62 Evacuation 58 Mirena Insertion 6 Cervical Encirclage 3 29 25 IUCD Removal 1 6 Cervical Cautery 1 3 1 1 1 1 1 Cervical biopsy 1 Bartholin’s Abscess 1 Anterior 1 Colporraphy September 3, 2011, Bangalore Jaya Bhat 4
  • 5. Ambulatory Gynecology Surgery Duration of Hospital Stay Type of Duration Surgery of Stay Majors 2 nights Others Same day discharge September 3, 2011, Bangalore Jaya Bhat 5
  • 6. Ambulatory Gynecology Surgery Complications - 2 Case 1 Case 2 Abdominal Suspected Vascular Distension Injury Shifted to Major Laparotomy Hospital CT Scan / Normal No Major Injuries Settled No Problems September 3, 2011, Bangalore Jaya Bhat 6
  • 7. Ambulatory Gynecology Surgery Our Results • Patients Satisfied • Good Pain Relief • No PONV • Ambulatory Surgery Effective September 3, 2011, Bangalore Jaya Bhat 7
  • 8. Ambulatory Gynecology Surgery Literature Survey -Study 1 Randomized Trial of Day Care Vs Inpatient Laparoscopic Supra cervical Hysterectomy Jelene Kisic Trop et al; AJOG 2011: 204:307-308 Randomized – 49 In patient – 25 Day Care – 24 Objective of the Study • Satisfaction with length of hospitalv Stay • Quality of Life September 3, 2011, Bangalore 8 Jaya Bhat 8
  • 9. Ambulatory Gynecology Surgery 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 September 3, 2011, Bangalore Jaya Bhat 9
  • 10. Ambulatory Gynecology Surgery 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 September 3, 2011, Bangalore 10 Jaya Bhat 10
  • 11. Ambulatory Gynecology Surgery Our Goal: to Introduce • ICD Coding • Protocols • Registry September 3, 2011, Bangalore Jaya Bhat 11
  • 12. Ambulatory Gynecology Surgery Thank You September 3, 2011, Bangalore Jaya Bhat 12