ABSTRACT
PIP: The article by Peter M. Layde, M.D., et. al (1981;245:714) warrants further comment and an update on the subject. Substantial reductions in the length of stay (LOS) after sexual tubal sterilization (STS) have been achieved in the past 5 years since those described by Layde et. al. Many contemporary facilities have now settled on a stay of 4-6 hours postoperatively, in fact, as the standard. In achieving this, the laparoscope was but 1 of the technical innovations contributing to the reduction, and other important changes were in progress over the last 10 years which brought the short LOS about. Favorable experience with STS by family planners in India and Southeast Asia during the early 1970s performed in freestanding clinics and tubectomy camps used little or no analgesia or anesthesia, and minimal postoperative supervision was needed for safe recovery. Later, Lubell and Frischer demonstrated that the concept of short stay was equally as safe and applicable in this country. Moreover, consumer demands for same-day surgery gave further impetus to this new trend. Additionally, because of economic motivations, 3rd party payers added further pressure toward the reduction in postoperative stay. Our personal experience with more than 500 patients undergoing vaginal tubal sterilizations performed under general anesthesia have proved the safety and utility of the short-stay approach to STS, regardless of the technology or methodology applied. No doubt when LOS statistics become available for STS in this country between 1975-9, enormous additional reductions in hospital time and monetary expenditures will be appreciated. Using the Association for Voluntary Sterilization estimate of 4 million women undergoing STS from 1976-9, and the reduction of the average LOS from 4 nights to no overnight stay, an impressive $160 million could be added to the estimate by Layde et. al of $200 million savings over the pre-1970 procedures. Finally, we take exception with the concept of "strike while the iron is hot" as it relates to the timing of STS. While it is inevitable that STS will continue to be requested and performed immediately after vaginal or cesarean births, this is probably the worst possible timing. The risk of complications, failure, or subsequent regret of having been sterilized is highest at that time. Day surgery makes interval STS cost-efficient and more readily acceptable to the sterilization candidate, and thus avoids those problems associated with puerperal sterilization.^ieng
