Uptake, views, opinions and practice of same-day discharge following total laparoscopic hysterectomy: a national survey of UK gynaecologists.

Abstract

Background: Total laparoscopic hysterectomy (TLH) is associated with reduced post-operative pain and enhanced recovery, allowing same-day discharge (SDD). However, adoption of SDD TLH is not established, and practice varies.

Objectives: To conduct a national survey of UK gynaecologists with an interest in laparoscopic surgery to obtain their views, opinions and experience of SDD TLH.

Methods: Members of the British Society for Gynaecological Endoscopy were invited to complete an online questionnaire between January 2023 and January 2024.

Main outcome measures: The questionnaire consisted of 16 questions about SDD TLH covering three domains: (i) service provision, (ii) prognostic variables and (iii) information giving and education.

Results: One hundred and forty-eight clinicians from 148/215 NHS hospitals (69%) responded. One hundred and thirty one (89%) respondents thought that SDD following TLH was beneficial, and 48 (32%) hospitals had an established service. Adequate pain control was considered the most important factor to achieve SDD TLH, followed by control of nausea and vomiting. Seventy-eight (53%) respondents removed the urinary catheter at the end of the procedure. All respondents believed that managing patients' expectations was important to achieve compliance with SDD and 123 (83%) thought that developing an online preadmission patient information resource was needed.

Conclusions: One third of UK NHS hospitals have a SDD TLH service but there is variation in availability and protocols (pre-, peri- and post-operative management). These data can help develop health service strategy to promote SDD after TLH and standardise protocols.

What is new?: The survey quantifies and demonstrates hospital-level variation in uptake and practice of SDD provision after TLH.