Same Day Surgery for My Hysterectomy?
By Margaret Mueller, MDWomen's Health October 25, 2017
One in 5 women have surgery for a pelvic floor disorder including urinary incontinence (leakage) or pelvic organ prolapse.
Given these striking numbers, significant advances in surgical procedures AND the pre-and postoperative care have been made to accommodate women. At the same time, much emphasis has been placed on enhancing patient safety and decreasing hospital stays. Here at Northwestern Medicine Integrated Pelvic Health Program, we offer a variety of minimally invasive same day surgeries to women seeking surgical management of their prolapse and/or incontinence symptoms.
“Wait, I can go home the same day of surgery?” is possibly the most commonly asked question by our patients who are considering surgery. And the answer we give is a resounding, “absolutely!” But that wasn’t always the answer. Commonly in our office, women share stories of their mothers, aunts, sisters, cousins and friends who underwent a gynecologic surgery and needed to stay overnight in the hospital.
The truth is that things have changed, and they didn’t change over night. We have seen an evolution over the past thirty years. Almost all major prolapse surgeries, even those that include a hysterectomy, are performed via a minimally invasive approach. This means that procedures that used to require a large incision can be performed laparoscopically through “key hole surgery” or vaginally, a technique that greatly reduces recovery.
To keep up with these surgical advances, we have refined the pre and postoperative care aspects as well. The initiative that has brought the most changes to surgical recovery is Enhanced Recovery After Surgery (ERRAS). Specifically, ERAS encompasses many aspects of perioperative preparation including optimizing pain control, hydration and energy before and after surgery. Research has shown that optimizing these aspects perioperatively allows women to have a smooth postoperative transition and recover quickly.
We also know that there is a large psychosocial aspect to recovery. Women recover better when they have support, from their surgical team as well as family. An integral part of ERAS is the pre-operative education and counseling. When you decide to proceed with surgical management of your prolapse, you won’t meet with just your surgeon. Rather you will meet with your pre-operative “team” who aims to optimize your surgical preparation. This team consists of doctors, nurses, advance practice nurses and the scheduling team who each play an individual role in helping you to prepare for every aspect of your upcoming procedure. We know that women who are better prepared, typically perceive better outcomes.
“So, what’s the problem with staying in the hospital?” you might ask yourself. And the answer is a simple one hospitals are for sick people. There are risks to being hospitalized, especially in the post-operative period. Some of the risks associated with hospitalization are serious and can have a detrimental effect on postoperative recovery, including blood clots and infections. Women having surgery who underwent ERAS protocol had fewer complications, likely related to a decreased length of hospital stay.
“I won’t have to be on bed rest for 3 months after surgery?” Sometimes, we have to dispel commonly held beliefs from doctors, not patients! A common myth among surgeons is that of restricted activity in the postoperative period. For many years women were told to avoid lifting anything heavier than 10 pounds for 3 months following gynecologic surgery. The advent of minimally invasive surgical procedures begged us to question this practice, and recent literature suggests that resuming normal activity postoperatively is safe and does NOT have a detrimental effect on the surgical outcome.
So bottom line, we’ve got you covered from the surgical procedure to the pre-, intra- and postoperative care to get you home and recovered as soon as possible! Research shows, that by getting you home the same day you will have less complications and have greater satisfaction than if you stayed the night. So leave your overnight bag at home!
To learn more about Northwestern Medicine's Integrated Pelvic Health Program, or to make an appointment, visit iphp.nm.org or call 312.694.7337.