Περίληψη:
Objective: The aim was to investigate whether outpatient hysterectomy
(OH) has benefits when compared with inpatient hysterectomy (IH)
regarding postoperative complications, readmissions, operative outcomes,
cost, and patient quality of life.
Data Sources: A systematic search for studies comparing OH with IH was
conducted through PubMed, SAGE, and Scopus from January 2010 to March
2020, without limitations regarding language and study design.
Methods of Study Selection: Studies reporting on the differences between
same-day discharge and overnight stay after hysterectomy were included.
The study outcomes were overall complication rate, type of complication,
readmission after discharge, surgery duration, estimated blood loss,
payer savings, hospital savings, and health-related quality of life
(HrQoL). Median and range are used to describe non-normal data, while
mean +/- SD and confidence interval are used to descibe data with normal
distribution. A meta-analysis with sensitivity analysis and subgroup
analyses was performed.
Tabulation, Integration, and Results: Eight studies published between
2011 and 2019 with 104,466 patients who underwent hysterectomy were
included in this systematic review and meta-analysis. All included
studies except 1 were found to have a high risk of bias. OH in
comparison with IH had a lower overall complication rate (odds ratio
[OR] 0.70; 95% confidence interval [CI], 0.60-0.82) and lower rates
of wound infection (OR 0.60; 95% CI, 0.43-0.84), urinary tract
infection (OR 0.64; 95% CI, 0.52-0.78), need for transfusion (OR 0.36;
95% CI, 0.22-0.59), sepsis (OR 0.33; 95% CI, 0.17-0.64), uncontrolled
pain (OR 0.79; 95% CI, 0.66-0.95), and bleeding requiring medical
attention (OR 0.82; 95% CI, 0.73-0.94). In addition, patients who
underwent OH had a lower readmission rate (OR 0.81; 95% CI, 0.75-0.87),
surgery duration (standardized mean difference -0.35; 95% CI, -0.61 to
-0.08), and estimated blood loss (standardized mean difference -0.63;
95% CI, -0.93 to -0.33) than those who underwent IH. A qualitative
analysis found that OH had a poorer patient HrQoL and a lower cost for
the hospital as well as the payer.
Conclusion: OHs present fewer complications and have a lower readmission
rate and estimated blood loss as well as a shorter surgery duration than
IHs. OHs also have a cost benefit in comparison with IHs. But patients
seem to have a worse HrQoL in the first postoperative week after OH. The
high risk of bias of the included studies indicates that well-designed
clinical trials and standardization of surgical complication reporting
are essential to better address this issue. (C) 2021 AAGL. All rights
reserved.
Συγγραφείς:
Ellinides, Andreas
Manolopoulos, Philip P.
Hajymiri, Melika and
Sergentanis, Theodoros N.
Trompoukis, Pantelis
Ntourakis,
Dimitrios
