Objective: To determine the cost-effectiveness, safety, and success of microsurgical tubal anastomoses performed by minilaparotomy as an outpatient.
Design: Retrospective.
Setting: Military tertiary care medical center.
Patient(s): Seventy consecutively seen women of reproductive age who were undergoing surgical reversal of sterilization from August 1, 1993, through August 1, 1995.
Intervention(s): Microsurgical sterilization reversal by minilaparotomy was performed as an inpatient (group 1, 47 patients) or as an outpatient (group 2, 23 patients).
Main outcome measure(s): Cost, complication rate, pregnancy rate.
Result(s): The procedure cost more for inpatients ($3,116) than for outpatients (!,456). Pregnancy rates were similar (56% in group 1 vs. 75% in group 2). There was only one complication in the series.
Conclusion(s): Outpatient microsurgical sterilization reversal performed by minilaparotomy is as safe and effective as the inpatient procedure and is less expensive.
PIP: A retrospective study conducted at a military tertiary care medical center in Portsmouth, Virginia (US), assessed the cost-effectiveness, safety, and success of microsurgical tubal anastomoses performed by minilaparotomy on an outpatient basis. The medical records of 70 consecutive women who underwent surgical sterilization reversal at the facility in 1993-95 were reviewed; 47 women received minilaparotomy as an inpatient procedure and 23 on an outpatient basis. All patients were seen in the clinic 2-4 weeks postoperatively and no significant complications were recorded. The total cost of the procedure was $3116 for inpatients and $1456 for outpatients. At follow-up (range, 19-43 months after surgery), the crude pregnancy rate was 56% in the inpatient group and 75% among women who underwent the procedure as outpatients. These findings indicate that minilaparotomy can be performed on an outpatient basis with significant cost savings but no adverse effect on patient safety. Appropriate preoperative counseling and postoperative follow-up are essential, however.