Guidance to support NHS providers to carry out more hysterectomy operations as day surgery has been developed by Getting It Right First Time (GIRFT), as part of a new ‘hysterectomy hub’ of resources.
GIRFT’s Best practice day case hysterectomy delivery guide draws on the learning of teams who are successfully delivering a day case hysterectomy pathway – sharing details of their processes, outlining potential steps, and offering practical guidance and advice for those trusts who wish to increase their own rates.
It is accompanied by a range of appendices and resources – including example trust documents, clinical protocols and patient information – all gathered together for convenience in GIRFT’s new gynaecology hysterectomy hub.
The GIRFT national report for maternity and gynaecology (2021) highlighted opportunities to reduce the length of stay (LoS) of women requiring a hysterectomy through the use of minimally invasive laparoscopic and vaginal surgery, which require less recovery time in hospital than open abdominal procedures. The use of such techniques can help trusts to further reduce LoS as they can be offered as day case surgery, driving down the 2022/23 average LoS of 3.97 days, which in turn can support the NHS drive for elective recovery.
However, there is wide variation in trusts using day case surgery for planned hysterectomy procedures, with 37% of benign hysterectomies performed as open abdominal procedures.
The GIRFT guidance, which is co-badged by the Royal College of Anaesthetists (RCoA) and British Association of Day Surgery (BADS) and supported by the Royal College of Obstetricians and Gynaecologists (RCOG), supports a move towards 25% or less of all hysterectomies carried out as open procedures. Of the remaining 75%, the ambition is for half to be completed as a day case procedure.
If all trusts were able to replicate best practice outlined in the guidance, there is the potential to unlock more than 22,000 bed days for the NHS.
"We know from the data GIRFT has gathered that there is an opportunity for services to expand the use of laparoscopic and vaginal hysterectomy techniques for the treatment of conditions such as endometriosis, fibroids, heavy menstrual bleeding, and prolapse. This guidance, alongside our new hysterectomy hub, can help teams to increase their use of minimal access techniques, increase day case rates, and to provide a better experience for patients and staff. We hope everyone involved in delivering hysterectomy surgery – medical and surgical teams, nurses, allied health professionals, operational managers and commissioners – will all find useful insights in the guidance to consider adopting some of the best practice we have captured into their own services.”
