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Master Thesis

AMetHYST (AMbulatory HYSTerectomy surgery) : faisabilité de l’hystérectomie en ambulatoire : étude prospective bicentrique

Abstract : Objectives: Since several years, outpatient surgery associated with ERAS protocols is among the national priorities and its development is supported by the French public authorities. The objective for the same-day surgery hospital takes is about 70% in 2022. In gynecology the outpatient surgery rate was estimated at 62,9% in 2018.The hysterectomy, one of the most frequent surgical procedure in women nowadays in France, is commonly performed by a minimally-invasive approach (laparoscopic or vaginal) following the French guidelines. However, the rate of the same-day hysterectomy is only 4,8%. The aim of our study was to evaluate the feasibility of the same-day minimally-invasive hysterectomy and to identify possible factors associated with success or failure of such an approach. Study design: We conducted a prospective double-center observational study at the Caen and Amiens University Hospitals between September 2017 and March 2018. We included hospitalized patients managed for a minimally-invasive hysterectomy (laparoscopic or vaginal). The patients were classified into a "fit" or "unfit" group according to their Post Anaesthetic Discharge Scoring System (PADSS) score calculated at 6 P.M. or 6 hours after surgery. We studied and compared the preoperative, peroperative and postoperative characteristics of patients from both groups. Results: Of the 152 included patients, 58,5% were placed in the "fit" group; i.e. patients leaving hospital the same day. The complication rate was 10,5%. From the examined factors before surgery, a history of laparotomy was the only predictive factor of the same-day discharge failure (OR=3,311; IC95%=[1,687-6,500], p=0,001). After surgery, the main barriers for the same-day discharge were intraoperative bleeding (p=0,019), pain (p<0.001) and postoperative nausea/vomiting (p<0.001). Conclusion: The same-day minimally-invasive hysterectomy is a feasible and safe procedure regardless indication. The eligible population is larger than expected, showing patients possibly older and presenting more co-morbidities. The patient preparation and the full adhesion of the surgeon to the protocol are essential criteria for this same-day hospital takes.
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Submitted on : Thursday, February 3, 2022 - 4:34:13 PM
Last modification on : Thursday, March 17, 2022 - 3:25:02 AM
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Margaux Pohl. AMetHYST (AMbulatory HYSTerectomy surgery) : faisabilité de l’hystérectomie en ambulatoire : étude prospective bicentrique. Médecine humaine et pathologie. 2021. ⟨dumas-03555540⟩



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