A national survey of UK practice for day-case vaginal prolapse surgery: Unrealistic expectations?

Objective: The UK NHS Getting It Right First Time report (2021) recommended that a significant proportion of native tissue vaginal prolapse operations should be undertaken as day -case procedures (target: 80% anterior compartment, 70% posterior compartment, 60% combined anterior/posterior compartment). The evidence for perioperative care, options for anaesthesia and outcomes of day -case vaginal prolapse surgery is limited. This study aimed to establish current practice amongst UK gynaecologists and explore perceived barriers to implementing day -case surgery for pelvic organ prolapse. Study design A pre -tested 16 -item survey was emailed to British Society of Urogynaecology members in July 2022. This survey recorded rates of day -case prolapse surgeries, barriers to implementation and practices for managing urethral catheters, vaginal packs, intraoperative anaesthetics and perioperative care. Responses to free -text questions were independently analysed by two of the authors and underwent thematic analysis. Results: 121 eligible responses were received (28 % response -rate): 41 % never undertook day -case prolapse repair, 16 % undertook < 5 per year and 26 % undertook > 20 cases per year. There was no significant difference in training level or hospital setting between those groups. Reasons cited for not undertaking day -case prolapse surgery included concerns about vaginal packs and urinary catheters (92 %) postoperative complications (67 %), early discharge of elderly patients (60 %) and a lack of published evidence (39 %) or national guidance (35 %). For those currently undertaking day -case prolapse surgery; 67 % used general anaesthesia, 15 % spinal with short -acting local anaesthetic, 14 % spinal with long -acting local anaesthetic and 3 % local anaesthetic alone. Vaginal packs and self -retaining urethral catheters were used by 68 % and 70 % respectively. Concerns regarding the management of vaginal packs and urinary catheters were the most frequently cited barrier to implementing day -case surgery for pelvic organ prolapse amongst free -text responses. There were wide variations in managing catheters and packs, and in managing readmissions. Conclusions: There is significant variation in uptake and practice for day -case prolapse surgery in the UK, with legitimate clinical concerns a barrier to its implementation. Further evaluation and development of robust, evidence -based management pathways are required to make day -case prolapse surgery consistent, feasible and defensible in clinical practice.