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5 dr jaya-bhat-an-audit-of-gynaecological-ambulatory-surgery_ncas_2011

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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