Recovery at home after major gynecologic surgery: how do our patients fare?

OBJECTIVES: To describe women's recovery and pain control during the first 6 weeks after hospital discharge after gynecologic surgery and estimate the prevalence of inadequate pain control during the first 2 weeks of home recovery after abdominal compared with vaginal gynecologic surgery.
METHODS: Participants, women without chronic pelvic pain undergoing benign nonlaparoscopic gynecologic surgery, completed daily evaluation of pain and pain medication use during the first 2 weeks after discharge and a validated recovery instrument 1, 2, and 6 weeks after discharge. Inadequate pain control was defined as a score of 4 or more (out of 10) on the four-item Surgical Pain Scale.
RESULTS: Of 140 eligible participants, 13 were lost to follow-up. Of remaining 127 women, 80 underwent vaginal and 47 abdominal surgery. Inadequate pain control was reported by 45% and 51% of women after vaginal and abdominal surgery, respectively, on recovery day 3 (P=.5); 23% and 30%, respectively, on day 7 (P=.4); and 5% and 23%, respectively, on day 14 (P<.005). Two weeks after discharge, 10% and 32% of women after vaginal and abdominal surgery, respectively, required narcotic pain medications (P<.01). By 6 weeks, approximately half of the women in either group reported they felt recovered and two-thirds felt "back to normal."
CONCLUSION: Pain control after hospital discharge is suboptimal for many women after both vaginal and abdominal surgery. The time to full recovery is longer than 6 weeks for half of women. Given increasingly rapid hospital discharge, optimizing the patient's experience at home is a priority. LEVEL OF EVIDENCE: II.