A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hours day case surgery setting



We read with interest the article by Penketh et al.1 Ten of 71 (14%) women, who were supposed to have 24-hour day case hysterectomy, were either admitted or readmitted, which is a very high percentage given the fact that this is a well-selected population. The overall incidence of unanticipated admission after ambulatory surgery ranged in various reports between 1.4 and 7.8%.2,3 The authors did not mention the percentage of women who had problems and contacted the provided helpline for advice, or those women who had morbidities and consulted their GPs or even had home visits. Furthermore, including seven cases of laparoscopic-assisted vaginal hysterectomy (LAVH) would have biased the data since it was well reported that LAVH was associated with lower incidence of vault haematoma with its subsequent morbidity and demand for medical care.4,5 This is because the surgeon has the advantage of having a second look at the end of the operation and securing any bleeding points.

The total number of women who underwent vaginal hysterectomy during the 5 years period of this study was not mentioned, and we expect that women included in this series to represent a small proportion in a busy teaching hospital and a tertiary referral centre. The question is whether it is worth implementing a setting that only suits a small sector, taking into consideration that inconsistency of delivering the care is confusing to the nursing and medical staff alike. Therefore, it might be safer for this cohort of women to be cared for similar to the majority.

Women’s satisfaction after the 24-hour day case surgery has never been objectively measured by a valid method. The authors made a very subjective assumption that this type of management will be greatly welcomed by women and quoted evidence for satisfaction based on cohort of women who had different types of surgery.6 We believe that people may compromise on the quality of service that they get on board to get cheap flight tickets from mass-selling companies, but nobody will be satisfied when counting the cost has the priority over counting the health and lives.