5 dr jaya-bhat-an-audit-of-gynaecological-ambulatory-surgery_ncas_2011
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Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 1
An Audit Of
GYNAECOLOGICAL AMBULATORY SURGERY
Nova Medical Centers, Koramangala
1ST Jun 2009 - 30th Jun 2011
Dr Jaya Bhat MD DGO FRCOG
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 2
Overview of Gynecology Cases
Gynecology Cases
No. of Surgeries
Total 461
Personal Series
319
Others 142
Personal Series,
319
Others, 142
Total Gynecology cases :461
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 3
Major surgeries : 31/319
Major Surgeries Number : 31
Vaginal
Hysterectomy
17
Total Abdominal
Hysterectomy
11
LAVH 1
Myomectomy 2
17
11
2 1
Total Major Surgeries - 31)
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 4
Other surgeries :258/319
101
62 58
29 25
6 3 1 1 1 1 1
Other Gynaecology (258) Other Surgeries Number of
Cases
Laparoscopy 101
D&C 62
Hysteroscopy 58
MTP 29
Suction & Evacuation
25
Mirena Insertion 6
Cervical Encirclage 3
IUCD Removal 1
Cervical Cautery 1
Cervical biopsy 1
Bartholin’s Abscess 1
Anterior Colporraphy
1
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 5
Duration of Hospital Stay
Type of Surgery
Duration of Stay
Majors 2 nights
Others Same day discharge
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 6
Complications - 2
Case 1
Abdominal Distension
Shifted to Major Hospital
CT Scan / Normal
Settled
Case 2
Suspected Vascular Injury
Laparotomy
No Major Injuries
No Problems
Ambulatory Gynecology Surgery
Our Results
• Patients Satisfied
• Good Pain Relief
• No PONV
• Ambulatory Surgery Effective
September 3, 2011, Bangalore Jaya Bhat 7
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 8 September 3, 2011, Bangalore Jaya Bhat 8 8
Randomized Trial of
Day Care Vs Inpatient
Laparoscopic Supra cervical Hysterectomy
Randomized – 49
Literature Survey -Study 1
Day Care – 24 In patient – 25
Jelene Kisic Trop et al; AJOG 2011: 204:307-308
Objective of the Study • Satisfaction with length of hospitalv Stay • Quality of Life
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 9
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
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 10 10
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
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 11
• ICD Coding • Protocols • Registry
Our Goal: to Introduce
Ambulatory Gynecology Surgery
September 3, 2011, Bangalore Jaya Bhat 12
Thank You