Low Pain Score After Total Laparoscopic Hysterectomy and Same-Day Discharge Within Less Than 5 Hours: Results of a Prospective Observational Study

Study objective: To present a descriptive study on same-day discharge after total laparoscopic hysterectomy (TLH), documenting the effectiveness of our preoperative and postoperative protocol, and surgical technique for minimizing postoperative pain scores in case of uterine volume equivalent to <14 weeks of gestation.

Design: Prospective observational study (Canadian Task Force classification II-2).

Setting: University hospital.

Patients: One hundred and five patients undergoing TLH, with same-day discharge.

Interventions: Anesthesia and surgery were performed using the same protocol in all patients.

Measurements and main results: Primary endpoints evaluated pain scores using a visual analog scale (VAS). Secondary endpoints included duration of surgery, operating room occupancy, time to discharge, overnight hospitalization, complication rate, readmission rate and patient satisfaction. All (100%) patients were able to return home within 4.9 ± 1.4 hours of surgery. At 1 hour after surgery, the mean VAS score was <4 (3.5 ± 2.6); the mean score dropped to <2 (1.9 ± 1.2) by 4 hours after surgery and remained so throughout day 1 (1.8 ± 1.4). Thus, VAS scores were significantly lower at 4 hours and day 1 postsurgery than at 1 hour postsurgery.

Conclusion: Our results clearly confirm that outpatient TLH is a feasible procedure, allowing same-day discharge and generating low levels of pain. Patients can leave the hospital in less than 5 hours after surgery. Standardized techniques, as well as coordination with the anesthesiologist, adequate postoperative nursing care, and preoperative patient counseling, are required.