Background
Hysterectomy is one of the most common surgical procedures performed each year with
substantial related health care costs. This trial studied the effect of postoperative
bladder backfilling to submicturition level in the operating room and its effect on
early postoperative patient care and related cost.
Objective
The objective of the study was to compare the effect of bladder backfilling on early
postoperative patient care and related cost.
Study Design
This was a randomized, single-blinded, controlled trial conducted between April 2016
and February 2017 at a single urban university hospital providing tertiary care for
minimally invasive gynecologic surgery. Ninety-one patients undergoing straight-stick
laparoscopic and robot-assisted hysterectomy by minimally invasive gynecologic surgeons
for benign indications were recruited. The bladder was partially backfilled with 150
mL of normal saline postoperatively in the intervention group and drained in the control
group, as per standard of care. Main outcomes studied were time needed to void, time
spent in the postanesthesia care unit, and postanesthesia care unit cost after minimally
invasive hysterectomy. Our secondary outcomes were postoperative complications.
Results
Forty-six patients (50.5%) were randomized to the intervention group, and 45 patients
(49.5%) to the control group. Baseline comparative analysis of demographics and preoperative
patient-specific variables, surgical history, intraoperative characteristics, and
administered medications found the 2 groups to be largely homogenous. After regression
analyses for adjustment, we found a significant reduction in the time needed to void,
time spent in the postanesthesia care unit, and postanesthesia care unit–associated
cost in the intervention group. Patients voided 64.9 minutes earlier than the control
group (P = .015) ans spent 64 fewer minutes in the postanesthesia care unit (P = .006), resulting in $401.5 (USD) saving per patient (P = .006). None of the patients encountered any postoperative complications.
Conclusion
Based on the findings of this randomized clinical trial, postoperative bladder backfilling
to submicturition level shortens the time needed for patients to void in the postanesthesia
care unit, resulting in shorter postanesthesia care unit stay and resultant cost savings.
Conservatively projecting our findings on minimally invasive hysterectomy procedure
is estimated to result in $69 million to $139 million (USD) per year in savings. Initiating
similar investigations in other ambulatory surgical fields will likely result in a
more substantial impact.
Key words
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Article info
Publication history
Published online: January 09, 2019
Accepted:
December 20,
2018
Received in revised form:
December 19,
2018
Received:
September 17,
2018
Footnotes
Dr Moawad is a speaker for Intuitive Surgical. The other report no conflict of interest.
Cite this article as: Moawad G, Tyan P, Marfori C, et al. Effect of postoperative partial bladder filling after minimally invasive hysterectomy on postanesthesia care unit discharge and cost: a single-blinded, randomized controlled trial. Am J Obstet Gynecol 2019;220:367.e1-7.
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© 2019 Elsevier Inc. All rights reserved.
