Fast-track Hysterectomy: A Pilot Study

Objective: Fast-track concepts have been applied in many perioperative settings. We developed an interdisciplinary fast-track vaginal hysterectomy protocol for selected patients. Methods: Inclusion criteria were: planned simple vaginal hysterectomy (without concomitant procedures), ASA status 1-2, request by the patient, and sufficient patient support at home. Patients were operated on early on the day of admission under regional or general anesthesia. Intraoperative criteria included preemptive analgesia, antibiotic prophylaxis, bipolar vessel sealing, and nonuse of drains and catheters. Postoperative criteria included pain management with PO medications, mobilization on the afternoon of surgery and early feeding. Complications and readmissions were recorded. Patients were contacted by questionnaire at 8 weeks postoperatively. Results: 12 patients were enrolled into the protocol during the pilot phase. Eight patients went home on the first, three on the second and one on the third postoperative day. The reasons for an extended in-hospital stay were postoperative nausea and vomiting (PONV) and organizational problems at home. There were no readmissions for complications. Nine women were satisfied with the duration of the stay, three considered it too short. Conclusion: Fast-track hysterectomy is feasible for selected patients. The main barriers to discharge on day 1 were PONV and organizational problems at home.