This document summarizes an audit of gynecological ambulatory surgery cases from June 2009 to June 2011. It presents data on 461 total gynecology cases, of which 319 were from a single physician. Major surgeries like hysterectomies comprised 31 cases, while other procedures like laparoscopy, D&C, and MTP comprised the remaining 258 cases. Patients typically had a 2-night stay for major surgeries and same-day discharge for other procedures. There were 2 reported complications. Literature reviews on similar studies found mixed results regarding patient satisfaction with ambulatory vs. inpatient surgery. The goal is to introduce ICD coding, protocols and a registry to further improve outcomes.

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