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Emergencies in gynecological surgery: feasibility of delayed day- care surgery management - 03/07/22

Doi : 10.1016/j.jogoh.2022.102437 
Perrine CAPMAS 1, 2, 3, , Karine NIKODIJEVIC 1, Delphine ROCCHI 1, Anne-Gaelle POURCELOT 1, Elodie DEBRAS 1, Hervé FERNANDEZ 1, 2, 3
1 Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, F-94276, Le Kremlin Bicetre, France 
2 Inserm, Centre of research in Epidemiology and population health (CESP), U1018, F-94276, Villejuif, France 
3 Faculty of medicine, Univ Paris Sud, F-94276, Le Kremlin Bicetre, France 

Corresponding author: Dr Perrine CAPMAS, Service de Gynécologie Obstétrique, Hôpital Bicêtre, 78 avenue du General LECLERC, 94270, Le KREMLIN BICETREService de Gynécologie ObstétriqueHôpital Bicêtre78 avenue du General LECLERCLe KREMLIN BICETRE94270
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ABSTRACT

Objective

Hospital-day-care surgery is currently a priority for the healthcare system and is booming due to its’ favorable financial impact. In gynecology, the management of surgical interventions for patients who've come to the Hospital Emergency Department, could in a number of cases, be delayed for a few hours or several days. It would be it possible to organize a specific hospital day-care management program for the delayed surgeries. The aim of the study is to evaluate the feasibility of hospital day-care management of delayed gynecological emergencies.

Methods

This is a prospective, observational, unicentric study performed in the gynecological department of a teaching hospital from January 2016 through March 2017. Women having gynecological emergencies requiring surgical management were included in this study. The leading causes for surgical management and thus for inclusion in this study were nonviable pregnancies or retained products of conception, vulvar or breast abscesses, ectopic pregnancies and complications of ovarian cysts. For women with emergencies that could be delayed, surgery was scheduled between 12 hours and 12 days after a woman's initial emergency examination at the hospital. Postoperative consultation was at the emergency department or completed by the referring physician. Re-hospitalization and re-intervention rates were collected 6 to 8 weeks after the initial emergency management.

Results

Three hundred and forty-eight women requiring surgical management consulted for gynecological emergencies over the period of the study. One hundred and eighty-one (52%) were managed in delayed day-care. The rate of surgical emergency management between the initial emergency consultation and the delayed day-care surgery was 1.8%. The consultation rate of a return to the emergency department prior to the planned delayed day-care was 12.2% (21/171). The rate of unplanned re-admissions in the month following surgery was 1.8% (3/171). The overall Satisfaction rate was high (170/171 99.4%).

Conclusion

The delayed surgical management of gynecological emergencies thus seems feasible and beneficial for both women and the healthcare system. An economic evaluation could be performed to evaluate the lower costs/savings for delayed day-care management of gynecological emergencies.

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Keywords : Gynecological surgery – Emergency – Ambulatory, Delayed day-care management


Plan


 This study was funded by ARS-ORCA (France).


© 2022  Publié par Elsevier Masson SAS.
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