Major Vaginal Surgery Research Articles

Outcomes of an Overnight-Stay Unit for Urogynecologic Surgery: Feasibility and Risk Factors for Failure of Next-Day Discharge.

To evaluate outcomes of patients undergoing urogynecologic procedures with postoperative care in an overnight-stay unit at a tertiary care center. A retrospective cohort study of 1644 women admitted to an overnight-stay unit at a Canadian tertiary care center after urogynecologic surgery between 2014 and 2018 was completed. A multivariable logistic regression model was fit to identify risk factors for failed next-day discharge, defined as a delayed discharge of more than 24 hours, readmission within 30 days of surgery, or emergency room assessment within 7 days of surgery. One thousand five hundred seventy-eight patients (96%) were discharged within 24 hours of surgery. Mean patient age was 53.7 ± 15.1 years, with 21.2% 70 years or older. Surgical approaches included laparotomies (8.9%), major vaginal surgery (70.9%), and open retropubic procedures (2.1%). Hysterectomies were performed in 1120 patients (68.1%). One hundred one patients (6.1%) were assessed in the emergency department within 7 days of surgery, and 57 (3.5%) were readmitted to hospital within 30 days of their procedure. Multivariable regression identified the following as risk factors for failed next-day discharge: pulmonary disease (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.32-8.06; P = 0.010), longer operating time (OR, 1.40; 95% CI, 1.10-1.79; P = 0.006, per 60 minutes), and intraoperative hemorrhagic complications (OR, 22.64; 95% CI, 5.83-88.00, P < 0.001). Admission to an overnight-stay unit with next-day discharge is feasible for most patients undergoing urogynecologic surgery. Factors associated with requiring a longer hospital stay, presentation to an emergency department, or readmission to hospital within 7 days include pulmonary disease, longer operating times, and intraoperative hemorrhagic complications.

Evaluation of preoperative cardiac risk index values in patients undergoing vaginal surgery

OBJECTIVE: Our purpose was to evaluate the Goldman and the New York Heart Association cardiac risk index values in a female surgical population and evaluate age, hypertension, ischemic heart disease, glucose intolerance, cardiac arrhythmia, and estrogen replacement therapy as risk factors for perioperative cardiac morbidity in older women undergoing major vaginal surgery. STUDY DESIGN: A retrospective analysis was performed of perioperative cardiac morbidity in consecutive patients undergoing elective vaginal surgery between August 1987 and October 1993. RESULTS: Four hundred six patients were entered in the study. Eight patients had perioperative cardiac morbidity. The Goldman cardiac risk index and the New York Heart Association functional classification of heart disease were not significant indicators of perioperative cardiac morbidity in this group of patients. In the postmenopausal subgroup of 168 patients hypertension ( p = 0.033) and ischemic heart disease ( p = 0.004) were statistically significant risk factors for perioperative cardiac morbidity. Glucose intolerance, cardiac arrhythmia, and estrogen replacement therapy were not significant predictors. CONCLUSION: The Goldman cardiac risk index and the New York Heart Association functional classification of heart disease are of questionable utility in a female surgical population undergoing elective vaginal surgical procedures. Hypertension and ischemic heart disease are risk factors for perioperative cardiac morbidity in a postmenopausal subgroup of these patients.

The Value of Cystoscopy in Major Vaginal Surgery

Section of Gynecologic Surgery and Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida. Obstet Gynecol 1994;84:318-320

The value of cystoscopy in major vaginal surgery: Pettit P.D.; Petrou S.P. USA Obstet Gynecol 1994 84/2 (318–320)

The value of cystoscopy in major vaginal surgery: Pettit P.D.; Petrou S.P. USA Obstet Gynecol 1994 84/2 (318–320)

A singleiv dose of ondansetron 8 mg prior to induction of anaesthesia reduces postoperative nausea and vomiting in gynaecological patients

The effect of a single intravenous dose of ondansetron in preventing postoperative nausea and emesis (retching and vomiting) (PONV) was investigated in a randomized, double-blind, placebo-controlled, multicentre, international study. Women of ASA class I-III, requiring gynaecological laparotomy, vaginal hysterectomy, or major vaginal surgery were selected for study. Two hundred and thirty-five received placebo, 231 received 1 mg ondansetron, 228 received 8 mg ondansetron and 229 received 16 mg ondansetron, as an infusion over five minutes before the induction of anaesthesia. A standardized balanced anaesthetic technique was employed. This consisted of premedication with either diazepam or temazepam, thiopentone induction, maintenance with nitrous oxide in oxygen supplemented with enflurane or isoflurane, intraoperative analgesia with fentanyl, neuromuscular blockade with any choice of agent and reversal with neostigmine and atropine. Postoperative analgesia was achieved with morphine, and prochlorperazine or metoclopramide were given if a rescue antiemetic was required. A greater percentage of patients in the 8 mg and 16 mg ondansetron groups experienced no postoperative emesis (44% and 39% respectively) than in the placebo and 1 mg ondansetron groups (29% and 28% respectively) for the first 24 hr postoperative period (8 mg vs placebo and 1 mg: P < or = 0.001; 16 mg vs placebo: P < 0.05; 16 mg vs 1 mg: P < 0.05). Similarly, the percentage of patients who did not experience postoperative nausea were 20%, 26%, 31% and 28% for the placebo, 1 mg, 8 mg and 16 mg ondansetron treatment groups, respectively (8 mg and 16 mg vs placebo P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular injuries during gynecologic surgery.

Iatrogenic vascular injuries are common in the civilian western world. The frequency seen following gynecologic surgery is not known and a questionnaire was therefore sent to all gynecologic clinics in Sweden undertaking surgery, to establish the frequency during a 5-year period and to analyse the types of injury. Case reports in the literature were also analysed. The frequencies per 10,000 operations were: after laparoscopy, 0.93, after laparotomy, 0.76 and after major vaginal surgery, 0.33. All laparoscopic injuries were localized to the iliac arteries, caused bleeding, and were treated with arterial suture without complications or late sequelae. Injuries during laparotomy were most frequently venous and all patients had hemorrhage as the main symptom. In one case the external iliac vein was ligated, with immediate postoperative swelling, and in another case the external iliac artery was ligated, after which the patient developed postoperative ischemia. The internal iliac veins were ligated, and the other vessels reconstructed. There was no mortality, but a high rate of morbidity, also with late sequelae.

Preparation of the Vagina for Surgery

Patients undergoing major vaginal surgery and treated with prophylactic antibiotics were assigned to two groups in which the effectiveness of preoperative vaginal preparation with povidone-iodine was compared with that of saline solution. There was no difference in postoperative morbidity between the two groups, although a few more infections occurred in the group treated with povidone-iodine. It is suggested that simple dilution of the quantity of bacteria in the vagina is all that is essential for adequate preoperative vaginal preparation.

Closed system of bladder irrigation and drainage after major vaginal surgery.

SummaryA system of closed bladder antiseptic irrigation and drainage was used after major vaginal surgery on 108 patients. The infection rates were 20 per cent when using chlorhexidine 1 in 5000 and 22 per cent with a 1 per cent solution of noxythiolin.

CONDUCTION ANAESTHESIA, BLOOD PRESSURE AND HAEMORRHAGE

SUMMARY Forty-five patients received lumbar epidural block for major vaginal surgery. Twenty-five of them had, in addition, light general anaesthesia (halothane, oxygen and spontaneous respiration). Measurements of blood loss and mean (integral) operative blood pressure were made. The group receiving halothane had a significantly lower mean integral operative blood pressure than the group receiving lumbar epidural block alone. The mean volume of haemorrhage in the two groups was not significantly different. The possible mechanism whereby conduction anaesthesia causes a relatively bloodless operating field for vaginal surgery is discussed.

BLOOD LOSS DURING MAJOR VAGINAL SURGERY: A Statistical Study of the Influence of General Anaesthesia and Epidural Analgesia

SUMMARY Blood loss was measured using a haemoglobin extraction-dilution technique in 211 patients undergoing major vaginal surgery. Epidural analgesia combined with light general anaesthesia was used in 102 patients. In 56 instances nitrous oxide and halothane were used, ventilation being spontaneous, and in 53 patients nitrous oxide, oxygen and a muscle relaxant were used together with passive pulmonary ventilation. When epidural analgesia was employed the mean blood loss was about one-third of that associated with the other forms of general anaesthesia. It was not found necessary to induce profound hypotension with epidural analgesia in order to provide satisfactory operating conditions. There was no statistically significant difference in blood loss was less in patients over 65 years than those under 65.

Paracervical and pudendal nerve blocks in major vaginal surgery

Paracervical and pudendal nerve blocks in major vaginal surgery

CARDIOVASCULAR DEPRESSION FOLLOWING MAJOR VAGINAL SURGERY

A series of 176 cases of major vaginal surgery have been followed through their immediate postoperative course and the incidence of hypotension in association with a relative bradycardia has been found to be high The possible aetiology and logical therapy have been discussed

Cardiovascular depression following major vaginal surgery

A series of 176 cases of major vaginal surgery have been followed through their immediate postoperative course and the incidence of hypotension in association with a relative bradycardia has been found to be high The possible aetiology and logical therapy have been discussed