Ambulatory hysterectomy vs ambulatory hysterectomy: systematic review and meta-analysis
Goal: The objective is to study whether ambulatory hysterectomies (OH) have advantages over hospital hysterectomies (HI) on postoperative complications, readmissions, operative results, cost and patient quality of life.
Information source: A systematic search for studies comparing OH to HI was conducted via PubMed, SAGE, and Scopus from January 2010 to March 2020, with no limitations in language and study design.
Study selection methods: Studies reporting the differences between same-day and overnight discharge after hysterectomy were included. The results of the study were the overall complication rate, type of complication, readmission after discharge, duration of surgery, estimated blood loss (EBL), payer savings, hospital savings, and quality of care. health-related life (HrQoL). A meta-analysis with sensitivity analysis and subgroup analyzes was performed.
Tabulation, integration and results: Eight studies published between 2011 and 2019 with 104,466 patients undergoing hysterectomy were included in the systematic review and meta-analysis. All of the included studies except one were at high risk of bias. OH compared to HI had a lower overall complication rate (OR: 0.70, 95% CI: 0.60-0.82), a lower rate of wound infection (OR: 0.60 95% CI: 0.43 to 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 to 0.94). In addition, patients with OH had a lower readmission rate (OR: 0.81, 95% CI: 0.75-0.87), duration of surgery (DMS: -0.35, 95% CI: -0.61, -0.08) and lower estimated blood loss (DMS: -0.63, 95% CI: -0.93, -0.33) compared to HI . Qualitative analysis revealed that the OH had a lower HrQoL and a lower cost to both the hospital and the payer.
Conclusion: OH has fewer complications, a lower readmission rate, lower estimated blood loss, shorter surgery time, and a cost / benefit ratio compared to HI, but patients appear to have less HrQol good during the first postoperative week after OH. The high risk of bias of the included studies indicates that well-designed clinical trials and standardization of reporting of surgical complications are essential to better address this problem.