Introduction of the day case total laparoscopic hysterectomy (TLH) protocol.

BACKGROUND: Traditionally total laparoscopic hysterectomy (TLH) patients are admitted for 1-2 days post-operatively. Day case TLH has been proven to be feasible and safe in other countries; however, this tertiary Queensland hospital is one of the first Australian institutions to introduce a day case TLH protocol. AIM: To pilot the implementation of our day case TLH protocol assessing the feasibility, safety and patient satisfaction of same-day discharge. MATERIALS AND METHODS: A retrospective audit of the implementation of our day case TLH protocol at a tertiary Queensland hospital was conducted. Primary outcome was length of post-operative hospital stay. Secondary outcomes included perioperative complications and post-operative re-presentation rates. Patient satisfaction was assessed through a patient questionnaire. RESULTS: Seventy-seven patients were included in the study. There were 94.81% patients who went home on the same day. Their average length of post-operative hospital stay was 7.72 (SD ± 3.36) hours. Of the patients who did achieve same-day discharge, the average length of stay was 7.05 (SD ±1.46) hours. There were no significant differences in perioperative complications or re-presentation rates compared to previously published literature. Patients reported they were extremely satisfied with day case TLH. CONCLUSION: The implementation of our day case TLH protocol is feasible, safe and well received by patients in our tertiary Australian hospital. These results can have multimodal effects in healthcare: decrease in hospital costs by reducing length of stay and overnight admissions, improved theatre efficiency and patient flow, while maintaining patient safety and satisfaction.

Delayed presentation of ACE inhibitor-induced angio-oedema.

We report two probable cases of delayed presentation of ACE inhibitor (ACEi)-induced angio-oedema. The first patient was on ACEi for more than 10 years while the second one was on it for 7 years. Both the patients presented with initial unilateral swelling of the tongue which progressed further to involve the soft tissues of the oropharynx, head and neck leading to a compromised airway needing awake fibreoptic intubation and were managed successfully in the intensive care unit (ICU). C1 esterase inhibitor and mast cell tryptase level was normal for both patients. Both were treated with intravenous antihistamines and corticosteroids in the ICU. Both patients were successfully extubated within 72 h and transferred to a medical ward. Age above 65 years, atopy and non-steroidal anti-inflammatory drug use may have been the predisposing factors. Both patients made a full recovery with no complications and the ACEi was ceased.