Recovery at home after major gynecologic surgery: how do our patients fare?

To describe women's recovery and pain control during the first 6 weeks after hospital discharge after gynecologic surgery and estimate the prevalence of inadequate pain control during the first 2 weeks of home recovery after abdominal compared with vaginal gynecologic surgery.

Participants, women without chronic pelvic pain undergoing benign nonlaparoscopic gynecologic surgery, completed daily evaluation of pain and pain medication use during the first 2 weeks after discharge and a validated recovery instrument 1, 2, and 6 weeks after discharge. Inadequate pain control was defined as a score of 4 or more (out of 10) on the four-item Surgical Pain Scale.

Of 140 eligible participants, 13 were lost to follow-up. Of remaining 127 women, 80 underwent vaginal and 47 abdominal surgery. Inadequate pain control was reported by 45% and 51% of women after vaginal and abdominal surgery, respectively, on recovery day 3 (P=.5); 23% and 30%, respectively, on day 7 (P=.4); and 5% and 23%, respectively, on day 14 (P<.005). Two weeks after discharge, 10% and 32% of women after vaginal and abdominal surgery, respectively, required narcotic pain medications (P<.01). By 6 weeks, approximately half of the women in either group reported they felt recovered and two-thirds felt "back to normal."

Pain control after hospital discharge is suboptimal for many women after both vaginal and abdominal surgery. The time to full recovery is longer than 6 weeks for half of women. Given increasingly rapid hospital discharge, optimizing the patient's experience at home is a priority.

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