Pelvic organ prolapse surgery: changes in perioperative management improving hospital pathway

There is growing interest in improving operating theatre efficacy and shortening stay in hospital. We made a retrospective patient record review looking at changes in the perioperative management of pelvic organ prolapse surgery during the period 2012 to 2014 in four hospitals in the Gothenburg area in Sweden.

We studied 440 pelvic organ prolapse surgery records; procedures performed during 2012, 2013 and 2014. Anterior colporrhaphy, posterior colporrhaphy and combined procedures were included. Patient characteristics, surgery, anesthetic technique, theatre time, surgical time, time in recovery room, and hospital stay was analyzed.

We found major changes in perioperative management at the same time as local anesthesia and sedation (LAS) increased. Operating room efficiency was increased; increased number of patients bypassed the recovery room and hospital stay was overall shortened, an increasing number of patients were discharged day of surgery. Patients discharge day of surgery increased from 24% to 72% between 2012 and 2014. Surgery under LAS increased from 87% to 96% of the procedures in the private hospital and from 18% to 83% in the university hospital between 2012 and 2014.

There is a clear change in perioperative care of patients undergoing pelvic organ prolapse surgery to a more enhanced perioperative management. Routine and practices differs however between hospitals. The use of local anesthesia and sedation improve theatre turn around and shortens hospital stay.