Perioperative Interventions to Facilitate Day-Case Vaginal Surgery for Pelvic Organ Prolapse: A Systematic Review

Multiple studies report good outcomes when performing day-case native tissue vaginal surgery for pelvic organ prolapse (POP). Despite this, consensus on optimal perioperative strategies to safely achieve same-day discharge (SDD) remain unclear and no complete protocol has been tested in a high-quality prospective study.

MedLine, PubMed, Scopus and Web of Science databases were searched from inception to May 2025 to identify English-language studies investigating perioperative interventions that facilitate day-case vaginal POP surgery. The primary outcome was successful SDD with secondary outcomes of patient satisfaction and rates of complications. Risk of bias and certainty of evidence were assessed using established tools (RoB2, ROBINS-I, MINORS, GRADE).

Searches identified 2345 studies, from which 30 studies (six RCTs, ten cohort, two case-control, 12 single-arm) met inclusion criteria. Early removal (2-6 h postoperatively) of vaginal packs and urinary catheters did not increase complication rates compared with removal on postoperative day one. Omission of vaginal packing was associated with improved SDD rates and had no adverse impact on complications. Enhanced recovery protocols were consistently associated with substantial improvements in SDD. No anaesthetic approach demonstrated clear superiority. Most patients, including older women, are suitable candidates for day-case surgery, though comorbidities and surgical complexity reduce the probability of SDD.

Day-case vaginal POP surgery is safe and achievable. Enhanced recovery principles, omission of routine vaginal packing and early catheter removal are all evidence-based interventions that would support its implementation. These findings should be incorporated into a comprehensive protocol and evaluated through a high-quality, prospective randomised trial.