Comparison of operative time, estimated blood loss and length of stay.

1. A Comparative Audit of Total Abdominal Hysterectomy, Subtotal Hysterectomy, Vaginal hysterectomy and Laparoscopically Assisted Vaginal Hysterectomy in a London District General Hospital N Shah1, N Agarwal2, S Ratcliff 2, M Manoharan 2.1Imperial College London,Chelsea & Westminster Hospital, London, UK; 2Chase Farm Hospital, Enfield, Middlesex, UK. SW10 9NH Introduction In our gynaecology department the majority of hysterectomies are still performed through a Pfannenstiel approach. However laparoscopically assisted vaginal hysterectomy (LAVH) has been shown to be associated with faster post-operative recovery, shorter stay in hospital, greater cosmetic purpose, less blood loss and fewer wound infections. This audit was designed to compare the efficiency of total abdominal hysterectomy (TAH) (n= 26), subtotal hysterectomy (SH) (n=7), and vaginal hysterectomy (VH) (n=13) and LAVH (n=7) in our unit. Complications Indication for surgery LAVH 1 patient readmitted 3 weeks post-op with pulmonary embolus and pneumonia 1 patient readmitted with vault granuloma. VH 2 patients re-catherised due to urinary retention 1 patient prolonged admission (6 days) for leg swelling (deep vein thrombosis) TAH and subtotal 2 patients had prolonged admissions due to poor pain control (>5 days) 1 patient developed a wound infection, 1 patient a urinary tract infection, 1 patient developed chest sepsis and 1 patient was transfused 3 units of blood post-operatively. Where indicated **values are mean + SD, *values are mean ± range Methods Study design was a retrospective case review over a twelve month period (March 2010 to April 2011). Data was collected from theatre records and medical notes (n=53). We recorded: baseline demographics including age, parity and BMI; indication for surgery; theatre time (surgical time only); estimated blood loss (EBL) and haemoglobin (Hb) difference before and after surgery; histological findings; length of hospitalisation; and complications. Comparison of operative time, estimated blood loss and length of stay. Conclusion There was a potential for many patients to be treated by VH or LAVH. The surgical time for LAVH and VH were greater than abdominal surgery. EBL was less in LAVH and VH andsupported by a smaller Hb drop. Average hospital stay was found to be similar for all types of hysterectomy despite expecting a reduced hospital stay with vaginal hysterectomy and laparoscopically assisted routes. This may have been due to the small number of VH and LAVH cases included in the data audited. Limitations include: different surgeons performing procedures, small number of cases. Improvements could include: larger sample size, inclusion of a pain score to assess quality of analgesia, follow up post hospital discharge (e.g. variables such as time to return to work) Results Baseline Demographics Mean operative time was comparable in the TAH and subtotal groups. Operative time was greatest in the LAVH and VH groups. EBL was lower in the LAVH and VH groups compared to abdominal routes. This finding was supported by Hb changes. Inpatient stay was slightly shorter in the LAVH group (mean 2.3 days) but there was little difference between TAH (2.9) / subtotal (3.3) and VH (3.2) groups despite an early discharge expected with VH. Limitations and improvements Barnet and Chase Farm Hospitals NHS Trust