To review the surgical and post-operative outcomes of patients who had vaginal repair surgery in a day case setting in a district general hospital.

We summarise data from prospective data collection and reporting in the urogynaecology national database  and patient medical records for all women who had vaginal repair surgery without hysterectomy by an single surgeon in  a district general hospital. All patients undergoing daycase vaginal surgery for POP over a period of nearly 7 years were included. Patients completed preoperative ICIQ-UI and ICIQ-VS questionnaires  before surgery. Postoperative questionnaires were then completed at the follow-up appointment after surgery.

Between December 2015 and August 2022, one urogynaecologist performed 71 vaginal repairs for 70 separate women. Following these procedures, 40 (56.3%) went home the same day and a further 24 (33.8%) the following day. Almost all patients who stayed overnight either had surgery later in the day and were discharged within 24 hours, or stayed for social support reasons. Two outliers included one woman that was investigated for chest pain (results were non-concerning) and another who had urosepsis.
These surgical procedures included: anterior repair (n=46), posterior repair (n=7), recto-enterocele repair (n=15), multiple vaginal repairs (n=3).
Seventeen of these women had had previous vaginal repairs either at our hospital or elsewhere. Twenty five women had trialed at least one vaginal pessary prior to surgical correction.
The median age of our patients at the time of surgery was 63 years [range 34-84 years], median pre-operative BMI was 29.2kg/m2 (mean = 29.7kg/m2), with a median and modal parity of 2 children, with all but one patient having had at least one vaginal delivery either spontaneously or with the aid of an instrument. 
The majority of women had general anaesthesia for their surgery (n=66), with 2 having regional anaesthetic and 3 having a combination of both. The median blood loss for these procedures was 100ml [range 50-350ml]. There were no increased rates of readmission or return to theatre.  At the postoperative clinic visit scheduled at 3 months, the majority of patients had a significant improvement in the postoperative ICIQ-VS scores.

More than half of the women operated on were discharged on the same day of surgery, and 90% overall were discharged within 24 hours. This applied to patients of all types of vaginal repair surgery, for women of all ages, many of whom had comorbidities. The majority who stayed overnight were either operated on late in the day, so early discharge was not appropriate, or needed additional social support. 
The median blood loss amongst our patients was 100ml, and patients did not require any post-operative haemoglobin checks. There was no increase in readmission post-operatively or the need to return to the operating theatre.
 
During the seven years included, there was a long period of time where elective surgery was not performed in our hospital due to the impact of the Covid-19 pandemic.

Vaginal repair surgery as a day case procedure is feasible in the majority of patients with POP, with its attendant benefits including  rapid recovery, reduction in venous thromboembolism risk and a lower risk of urinary tract infection from prolonged catheterisation. Furthermore this pathway can facilitate the reduction of the surgical waiting lists post Covid-19 health service recovery, as inpatient bed occupancy is not a limiting factor in the number of cases that can be performed. Daycase vaginal  repair is also cost effective and allows better utilisation of resources with reduces hospital stay and bed occupancy, without an increase in postoperative morbidity requiring additional hospital visits or procedures.