Gynecologic Population Research Articles

Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients: A Propensity Score Matching Study.

This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population. This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022. Data were collected for each patient, including demographics, disease status, surgical data, and clinical information. Preoperative bowel preparation, postoperative gastrointestinal function, and electrolyte levels were compared between the two groups using propensity score matching (PSM). The incidence of hypokalemia (serum potassium level <3.5 mmol/L) during the recovery period from anesthesia was approximately 43.75%. After PSM, oral laxative use (96.4% vs. 82.4%, P=0.005), the number of general enemas (P=0.014), and the rate of ≥2 general enemas (92.9% vs. 77.8%, P=0.004) were identified as risk factors for hypokalemia, which was accompanied by decreased PaCO2 and hypocalcemia. There were no significant differences in postoperative gastrointestinal outcomes, such as the time to first flatus or feces, the I-FEED score (a scoring system was created to evaluate impaired postoperative gastrointestinal function), or postoperative recovery outcomes, between the hypokalemia group and the normal serum potassium group. Hypokalemia during postanesthesia recovery period occurred in 43.75% of gynecological patients, which resulted from preoperative mechanical bowel preparation; however, it did not directly affect clinical outcomes, including postoperative gastrointestinal function, postoperative complications, and length of hospital stay.

The Role of Ureaplasma and Mycoplasma Species in Recurrent Lower Urinary Tract Infection in Females: A Scoping Review.

It is unknown if recurrent urinary tract infection in the gynecologic population is associated with Mycoplasma and Ureaplasma genitourinary infections. The purpose of this scoping review is to highlight the literature surrounding Mycoplasma and Ureaplasma infections in the setting of recurrent urinary tract infections in the gynecologic population. MEDLINE ALL and Embase were searched to retrieve articles published in or after 1950 through 2024. Studies included were those with adults over age 18, non-pregnant, diagnosed with recurrent urinary tract infection and concurrent genitourinary infection with Ureaplasma or Mycoplasma published in English. Study designs eligible were quantitative, qualitative, and mixed methods studies. Publication types were also extended to conference abstracts and unpublished data. 2 independent investigators systematically performed title/abstract screening and full-text review using standardized inclusion criteria. For disagreements in either title and abstracts or full-text articles, consensus was reached through discussion by the 2 screeners and/or a 3rd final adjudicator. Screening and data extraction were performed on Covidence, a web-based platform for systematic review management. There were 1170 studies identified before title and abstract screening. 26 full-text articles were reviewed for eligibility. Of these, 23 full-text studies were excluded. 3 studies met full inclusion criteria and data extraction was performed on these 3 studies. There were 2 additional studies included after identification via other methods. There is a need for more recent and robust studies examining the role of Ureaplasma and Mycoplasma genitourinary infections amongst gynecologic patients with recurrent urinary tract infections.

Association of Diastasis Recti Abdominis with Pelvic Floor Muscle Strenth and Urine Incontinence in Gynecological Population

Purpose: Diastasis recti abdominis (DRA) denotes an anomalous separation of the rectus muscles throughout their longitudinal axis, devoid of fascial irregularities. The current study sought to determine the prevalence of DRA and its potential association with pelvic floor muscular strength and urinary incontinence in the gynaecological population of Faisalabad. This was a cross-sectional study.&#x0D; Materials and Methods: A Convenient sampling technique was used for collecting data. A sample of 100 females from government hospitals of Faisalabad was taken. Study was conducted in Faisalabad from February 2018 to May 2018. Inclusion criteria of the research was, immediate postpartum ladies, females aged 18 to menopausal age, and females who had normal vaginal birth. Manometric techniques were employed to quantify the strength of the pelvic floor muscles (PFMS), with outcomes represented in cmH2O. The incidence of urinary incontinence (UI) was ascertained by querying patients regarding any manifestations postpartum. The extent of diastasis recti abdominis (DRA) was gauged utilizing fingerbreadth assessments of the rectus abdominis muscles. This particular measurement spanned a distance of 4.5 cm both superior and inferior to the umbilicus, aligned with the linea alba.&#x0D; Findings: Results were analyzed through SPSS version 26. Diastasis recti abdominis was found to be present in 57% of the females. 7% of the women had very weak pelvic floor muscle, 38% had weak, 50% had moderate strength and 5% had good strength of pelvic floor muscles. Out of 100, urine incontinence was found in 59% females. There was no statistically significant correlation observed between diastasis recti abdominis muscle and either urinary incontinence or pelvic floor muscle strength, with a p-value exceeding 0.05.&#x0D; Implications to Theory, Practice and Policy: Incorporate routine DRAM screening for postpartum gynecological patients. Educate women about DRAM, its risk factors, and prevention strategies. Promote postpartum exercises and physical therapy to strengthen abdominal muscles and pelvic floor. Provide nutritional counseling to address obesity, a risk factor for DRAM. Implement a multidisciplinary approach involving gynecologists, physiotherapists, and nutritionists. Conduct additional research on the long-term consequences of DRAM and effective interventions. Conduct awareness campaigns targeting both healthcare providers and the public to increase DRAM awareness.

Prevalence of Diastasis Recti Abdominis in a Gynecological Population: A Cross-Sectional Study

Background: Diastasis recti is the divarication of rectus abdominal muscles due to the splitting of the mid-line collagen structure called the linea alba. It results in poor body biomechanics and alteration in the center of gravity of the body. It occurs mostly in multiparous females and in those who have poorly toned abdominal musculature. Physical activity and maternal care are significant to resolve this condition. Objective: The purpose of the study is to substantiate the prevalence of diastasis recti in a sample of immediate post-partum females attended by the Allied Hospital of Faisalabad. The aim is to create awareness of DRAM in clinical settings and the general population. Study design: This is a cross-sectional study that included 90 samples of females in the immediate postpartum period. Methodology: Specific assessment was done by finger-width method manually and confirmed the presence of DRAM. The umbilical region was the set point from which measurements were taken. Results and Conclusions: The separation was present and mostly affected the multiparous females. The study showed 63.3% prevalence and normal rectus abdominis is 36.7%. It also verified that 42.2% of females suffered from DRAM above the navel out of 63.3% and the rest are below the umbilicus. DRAM was prevalent to be in the majority of post-partum females. It was more present in the supra-umbilical region. Keywords: Pregnancy, rectus abdominis, multiparous, primiparous, physiotherapy.

A pilot evaluation of social needs among gynecologic oncology patients in inpatient versus outpatient settings

The WHO defines social determinants of health (SDoH) as the conditions in which we are born, grow, work, and live as well as other large systems that positively or negatively affect our health. Many healthcare systems currently lack the resources and strategies required to accurately assess and address SDoH. Action must be taken because studies have found that chronic diseases, including cancer, are affected by SDoH. The aim of this study is to identify the incidence of social needs in an inpatient gynecologic oncology population and its relation to patient demographics and clinical diagnostic data to guide and inform future intervention. Patients agreeing to participate in the study completed a needs assessment survey during their inpatient stay at the hospital between November 2020 to March 2021. The survey contained seven questions, six of which were questions screening for social needs including food and housing security, transportation means, financial stability, health literacy, and social support. Responses were considered positive if any degree of need was reported. Demographic and cancer diagnosis data were then collected and included zip code, race, cancer stage and age at diagnosis, treatment history, and number of hospital admissions and length of stay over the past 12 months. The most substantial reported needs across all gynecologic malignancies were social support (65%), health literacy (37%), and financial need (22%). Less need was reported in the categories of food (11%), housing (7%), and transportation (4%). SDoH have been studied in the outpatient gynecologic population and the needs seen in this study are similar to the needs of that population. However, there are likely different challenges and frequencies of unmet need in the different types of gynecologic cancers that may affect the stage at which their cancer is diagnosed as well as the number of hospital admissions related to their cancer care.

107. Rates of Inflammatory Bowel Disease in Patients with Endometriosis in the Pediatric Adolescent Gynecology Population at Texas Children's Hospital, Houston, Texas

107. Rates of Inflammatory Bowel Disease in Patients with Endometriosis in the Pediatric Adolescent Gynecology Population at Texas Children's Hospital, Houston, Texas

Prevalence and Bother of Postvoid Dribbling and Urine Spraying or Splitting: Survey of a General Gynecology Population.

Postvoid dribbling is described well for men in urologic literature but is poorly defined for women, especially in those not presenting for urogynecologic care. The objective was to assess prevalence and bother of postvoid dribbling, urine spraying (ie, deviation of the urine stream), and other bothersome voiding/storage symptoms in a general gynecology population. This was an anonymous cross-sectional survey study of women presenting to academic general gynecology practices for benign gynecologic care or well-woman visits; patients were not presenting for urinary incontinence or voiding dysfunction. A questionnaire was used to assess the presence and perceptions of voiding behavior and urinary symptoms with an emphasis on postvoid dribbling and urine spraying. The questionnaire included both the validated Questionnaire for Urinary Incontinence Diagnosis and nonvalidated questions. Nonpregnant adult women (N = 355) were surveyed. The median age was 43 years (interquartile range, 33-51 years). The sample was 45% White, 23% Black, 3% Asian, and 13% other. Furthermore, 39% were Latina; 68%, parous; and 28%, postmenopausal. The prevalence (95% confidence interval) of immediate postvoid dribbling was 186 of 327 or 57% (51-62%), and of these, it was at least somewhat bothersome in 37% but moderately-to-quite-a-bit bothersome in 8%. Urine spraying occurred in 222 of 333 or 67% (61-72%), and of these, it was at least somewhat bothersome in 53% but moderately-to-quite-a-bit bothersome in 17%. Approximately 20% reported stress and/or urgency urinary incontinence; both postvoid dribbling and urine spraying were highly associated with these symptoms. This study of women seeking benign gynecologic care shows a high prevalence of postvoid dribbling and urine spraying symptoms. However, moderate-or-greater bother was relatively uncommon.

Obstetrics and Gynecology Emergency Department Activity during Lockdown in a Teaching Hospital, Hub Center, for COVID-19

Background The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19. Methods The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the “PSNet” triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary. Results The relative decrease of patients presenting to OGED in 2020 was −50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = −79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = −40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = −61.58%) and green (Δ = −52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = −70.42%), pain (p ≤ 0.0001; Δ = −81.22%), urinary diseases (p = 0.004; Δ = −75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = −87.50%). Conclusions An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID‐19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.

To block or not to block? That is the question (114)

Objectives: Quadratus Lumborum (QL) blocks have gained popularity due to their more favorable safety profile compared to neuraxial techniques (e.g., epidural) in dealing with postoperative pain. They have been studied in the gynecologic population undergoing laparoscopic surgery, where pain scores were found to decrease as patients progressed through their recovery process. Yet, very little data exists studying their use in open surgery for gynecologic indications. Therefore, we aimed to determine the effect of QL blocks on postoperative opioid consumption in patients undergoing laparotomy. Methods: A retrospective study of gynecologic oncology patients undergoing surgery via laparotomy from 2018 to 2020 was performed. Demographics, postoperative pain scores, frequency, and duration of narcotic use, amount of narcotic use using Morphine Milligram Equivalents (MME), length of hospital stay, and re-admission rates for pain management were compared. Primary outcome measures include postoperative pain scores and the amount of narcotic use in MME. Results: Thirty-eight patients who met the inclusion criteria with complete data were identified as receiving QL blocks, whereas 32 patients did not receive a block during this time frame. Eighty-six percent of the blocks were placed preoperatively. Approximately 25% of patients reported their pain score on arrival to the floor as 0 out of 10. The mean pain score for patients with and without QL blocks on arrival to the floor were 2.9/10 and 3.7/10, respectively (p=0.57). Patients who received QL blocks used a mean of 18.4 MME on postoperative day 1 compared to 31.1 MME in those without blocks (p=0.008). This trend continued throughout their hospital course as the mean total MME used on hospital days 1-3 in the QL group was 49.11 compared to 80.24 in the non-QL group (p=0.009). Conclusions: Our study suggests that the use of regional QL blocks decreases the amount of narcotic pain medication (MME) used in the immediate postoperative period in patients undergoing laparotomy for gynecologic oncology indications. This is an important finding which may help decrease overall postoperative narcotic requirements given the current opioid epidemic. Future studies will focus on the impact of QL blocks on narcotic need after discharge in this patient population. Objectives: Quadratus Lumborum (QL) blocks have gained popularity due to their more favorable safety profile compared to neuraxial techniques (e.g., epidural) in dealing with postoperative pain. They have been studied in the gynecologic population undergoing laparoscopic surgery, where pain scores were found to decrease as patients progressed through their recovery process. Yet, very little data exists studying their use in open surgery for gynecologic indications. Therefore, we aimed to determine the effect of QL blocks on postoperative opioid consumption in patients undergoing laparotomy. Methods: A retrospective study of gynecologic oncology patients undergoing surgery via laparotomy from 2018 to 2020 was performed. Demographics, postoperative pain scores, frequency, and duration of narcotic use, amount of narcotic use using Morphine Milligram Equivalents (MME), length of hospital stay, and re-admission rates for pain management were compared. Primary outcome measures include postoperative pain scores and the amount of narcotic use in MME. Results: Thirty-eight patients who met the inclusion criteria with complete data were identified as receiving QL blocks, whereas 32 patients did not receive a block during this time frame. Eighty-six percent of the blocks were placed preoperatively. Approximately 25% of patients reported their pain score on arrival to the floor as 0 out of 10. The mean pain score for patients with and without QL blocks on arrival to the floor were 2.9/10 and 3.7/10, respectively (p=0.57). Patients who received QL blocks used a mean of 18.4 MME on postoperative day 1 compared to 31.1 MME in those without blocks (p=0.008). This trend continued throughout their hospital course as the mean total MME used on hospital days 1-3 in the QL group was 49.11 compared to 80.24 in the non-QL group (p=0.009). Conclusions: Our study suggests that the use of regional QL blocks decreases the amount of narcotic pain medication (MME) used in the immediate postoperative period in patients undergoing laparotomy for gynecologic oncology indications. This is an important finding which may help decrease overall postoperative narcotic requirements given the current opioid epidemic. Future studies will focus on the impact of QL blocks on narcotic need after discharge in this patient population.

The Use of Therapeutic Inhaled Essential Oils (TIEO) as a Holistic Approach to Decrease Preoperative Anxiety in ERAS Gynecological Surgery

IntroductionPreoperative anxiety is a negative symptom frequently experienced by surgical patients. This evidence-based-practice (EBP) project evaluated the effectiveness of therapeutic inhaled essential oils (TIEO) on anxiety levels during the preoperative phase of surgery in enhanced recovery after surgery (ERAS) gynecological patients ages 18 to 65 years old. MethodsA prospective, preposttest, quasiexperimental design was used to evaluate preoperative anxiety scores. Patients (N = 53) scheduled for gynecological surgeries were enrolled at a level II trauma center. Upon arrival to the preoperative area on the day of surgery, patients were asked to score their anxiety level using the Visual Analog Scale for Anxiety (VAS-A). Patients were provided the TIEO intervention during their preoperative phase of surgery ranging from 15 to 60 minutes. Patients were encouraged to take mindful deep breaths and inhale the essential oil vapor. Before being transported into the operating room, patients were asked to re-evaluate their anxiety level using the VAS-A. ResultsA matched paired t-test revealed the post-VAS-A measurements were significantly lower (n = 52, M = 31.37, SD = 24.334) than the pre-VAS-A measurements (n = 52, M = 53.50, SD = 26.863), t51 = 8.756, P = .000). On average, postanxiety scores were 22.135 mm lower than pre-anxiety scores (95% CI [17.060, 27.209]). ConclusionsThe use of TIEO demonstrated a statistically significant decrease in preoperative anxiety scores within the ERAS gynecological population. TIEO can be used as an adjunct intervention to manage preoperative anxiety. TIEO can be successfully administered in the preoperative area. Decreasing anxiety in the preoperative period may lead to many perioperative benefits such as improving surgical outcomes, patient satisfaction, and quality of care.

Understanding The Comorbidities That Increase the Cardiovascular Risk in The Gynecologic Population of Our Hospital

Introduction: Obesity, diabetes mellitus (DM2), high blood pressure (HBP) and dyslipidemia are widely recognized factors of increased cardiovascular risk. Objective: The primary objective of our study was to determine the prevalence of obesity, DM2, HBP and dyslipidemia in our hospital population The secondary objective was to compare the above-mentioned risk factors between premenopausal (preM) and postmenopausal (postM) populations. Materials And Methods: A descriptive, retrospective and cross-sectional study was conducted in 1,143 women aged 25 to 65 years domiciled in the Metropolitan Area of Buenos Aires (AMBA, for its acronym in Spanish), who participated in the "Campaign for the prevention of cervical cancer and early detection of breast cancer” carried out in 2020 by the Gynecology Service of Hospital de Clínicas "José de San Martín", University of Buenos Aires (UBA). A survey was conducted to collect epidemiological data from patients. Blood pressure, weight and height measurements were performed in addition to the gynecological examination. The prevalence of different risk factors was estimated and compared according to the reproductive status using Fisher´s test. Results: The body mass index (BMI) of 1138 patients out of a total population of 1143 patients was obtained. The average BMI was 28.66 Kg/m2; 37.17% of the patients had obesity (35.13% in premenopausal women [preM] versus 40.73% in postmenopausal women [postM]). Among a total of 1128 patients, the prevalence of DM2 was 4.08% (2.23% in preM versus 7.26% in postM). Among 1130 patients, 12.48% had HBP (5.87% in preM versus 23.85% in postM) and among 1131 women,2.47% reported dyslipidemia (1.26% in preM versus 4.57% in postM). When comparing the populations according to the menopausal status, a significant increase was found in the prevalence of obesity (p 0.03), DM2 (p &lt;0.001), HBP (p &lt;0.001) and dyslipidemia (p &lt;0.001) in postmenopausal women. Conclusions: We observed lower prevalence rates ofDM2 and HBP than in the general population. This may be attributed to the fact that the information was self-reported by patients and not confirmed by clinical examinations. However, we are surprised at the high prevalence of obesity in our population. All cardiovascular risk factors were statistically more prevalent in postmenopausal than in premenopausal women.

Adnexal Torsion Salvage Rates During the COVID-19 Pandemic in a Pediatric and Adolescent Gynecology Population

Background: Early diagnosis and surgical intervention for adnexal torsion (AT) increases the likelihood of ovarian salvage. The COVID-19 pandemic has introduced barriers that may delay time from symptom onset to intervention due to delayed presentation and requirement for COVID-19 testing preoperatively. The objective of this study was to determine any differences in ovarian salvage rates during the COVID-19 pandemic in a pediatric & adolescent gynecology (PAG) population compared to prior to the pandemic.

Pediatric and Adolescent Gynecology Population's Satisfaction with Telemedicine Consultation on Contraception During the Covid-2019 Pandemic

Background: The use of telemedicine consultation is becoming a promising alternative to face-to-face practices for all healthcare providers especially since the Coronavirus 2019 pandemic. Overall high-level of patient satisfaction with telemedicine has been highlighted in literature, but to our knowledge no specific research has been conducted on a Pediatric and Adolescent Gynecology (PAG) population especially for contraception purposes.

Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study.

BackgroundWith the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction.Objective This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population.Methods We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient.Results A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ≥9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ≥9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ≥9).Conclusions Postoperative text messages increased patients’ perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate.

Effects of a cognitive behavioral intervention on salivary cortisol levels in post-operative gynecologic oncology population: A randomized control trial

Effects of a cognitive behavioral intervention on salivary cortisol levels in post-operative gynecologic oncology population: A randomized control trial

Upstream oncology: identifying social determinants of health in a gynecologic oncology population

Introduction: Social determinants of health (SDoH) are the factors that affect a patient’s health quality and outcomes and contribute to health disparities. Evidence suggests that clinical care contributes only 20% to patients’ health outcomes, while the remainder is under the influence of upstream factors. The upstream approach to healthcare aims to address SDoH before they contribute to less ideal outcomes downstream. Several SDoH may contribute to outcomes for cancer patients. This Upstream Gynecologic Oncology Initiative seeks to identify which SDoH affect a population of patients with gynecologic malignancies. Hypothesis: This study hypothesizes that women receiving care for gynecologic malignancies are affected by specific SDoH among the categories of housing, food, transportation, finances, health literacy and social support. This study aims to identify the frequency of these six social factors among the outpatient gynecologic oncology population at the University of Iowa. Methods: This needs assessment is the first phase in a quality improvement project assessing the SDoH affecting women with gynecologic cancers. Two hundred twenty-two patients receiving outpatient care for gynecologic malignancies completed an anonymous needs assessment survey. Validated survey questions regarding housing, food, transportation, finances, health literacy and social support were used to identify needs. Responses were considered positive if any degree of need was reported. Results: Responses demonstrated the most substantial need in the categories of social support (32%), health literacy (28%) and financial stability (24%). Less need was reported in the categories of food (11%), transportation (5%) and housing (4%). Fifty-seven percent of women reported at least one social need among the six categories screened. Conclusion: Upstream SDoH, most notably social support, health literacy and financial stability are identified to be present and likely contributing to health quality, outcomes, and disparities within this gynecologic oncology patient population. Overall, these findings support the idea that SDoH should be assessed for each unique patient population - and for each patient receiving care for gynecologic cancer. While social support was the most frequently reported SDoH, many patients already received adequate help at home; suggesting that meaningful efforts should next be directed at improving health literacy in the population. Appreciation and assessment of SDoH potential to impact care and management should be used to design a routine screening tool for the study population and organize resources to address or mitigate the identified needs.

Surgical Aspects of Adhesiolysis and Adhesion Barriers for Today’s Surgeon: A Call for More Robust Research

Adhesions can cause symptoms of pelvic pain, infertility, and bowel obstruction in reproductive and postmenopausal women. The topic of adhesiolysis and adhesion barriers in gynecology has been studied in small, heterogeneous studies with very low to moderate quality. The efficacy for prevention and treatment strategies of adhesive disease in the gynecologic population will be reviewed here.

Risk assessment for postoperative outcomes in a mixed hospitalized gynecological population by the Dutch safety management system (Veiligheidsmanagementsysteem, VMS) screening tool \u2018frail elderly\u2019

PurposeFrailty is associated with a higher risk for negative postoperative outcomes. This study aimed to determine the association between the screening tool of the Dutch safety management system, Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ and postoperative complications in a gynecological population.MethodsThis cohort study included women aged 70 years or older, who were scheduled for any kind of gynecological surgery. VMS screening data (including risk for delirium, falling, malnutrition, and functional impairment) were extracted from the electronic patient records. VMS score could range between 0 and 4 patients with a VMS score of one or more were considered frail. Data on possible confounding factors and complications within 30 days after surgery, classified with the Clavien–Dindo classification, were collected. Regression analysis was performed.Results157 women were included with a median age of 74 years (inter quartile range 71–79). Most patients underwent prolapse surgery (52%) or hysterectomy (31%). Forty-one patients (26%) experienced any postoperative complication. Sixty-two patients (39%) were considered frail preoperatively by the VMS screening tool. Frailty measured with the VMS screening tool was not independently associated with postoperative complications in multivariable analysis (Odds ratio 1.18; 95% CI 0.49–2.82). However, a recent fall in the last 6 months (n = 208) was associated with postoperative complications (Odds ratio 3.90; 95% CI 1.57–9.66).ConclusionAn independent association between frailty, determined by the VMS screening tool ‘Frail elderly’, and postoperative complications in gynecological surgery patients could not be confirmed. A recent fall in the last 6 months seems associated with postoperative complications.

Anesthetic management for robotic hysterectomy in obese women.

Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. In the general gynecologic population, minimally invasive surgery is associated with less postoperative fever, pain, hospital length of stay, total cost of care and an earlier return to normal function. This also applies to robotic surgery in obese patients, which is on the rise. The physiologic changes of obesity bring different anesthetic challenges, including airway management and intraoperative ventilation. Vascular access and intraoperative blood pressure monitoring can also be challenging and require modifications. Optimizing analgesia with a focus on opioid-sparing strategies is crucial due to the increased prevalence of OSA in this patient population. Anesthesia for obese patients undergoing robotic hysterectomy is challenging and must take into consideration the anatomic and physiologic changes associated with obesity.

66. Vacutainer Tube Alternative Vaginoscopy Technique in a Prepubertal Female: A Case Report

<h3>Background</h3> Vaginoscopy is a recommended procedure for multiple indications in the pediatric and adolescent gynecology population. The use of a small sterile tube for circumferential tissue visualization with a fiberoptic scope is used for anoscopy, and has not been suggested as a technique for vaginal tissue visualization during pediatric vaginoscopy. <h3>Case</h3> A 5-year-old female presented to the emergency room with vaginal bleeding from a vulvar straddle injury caused by a fall onto a metal trampoline spring. She was brought to the operating room where a deep laceration at the posterior fourchette to the rectal capsule was repaired surgically. Routine vaginoscopy was attempted by hysteroscope-instilled saline, but adequate vaginal distension was not obtained despite trouble-shooting the equipment. A modified technique using a sterile glass tube was suggested by pediatric surgery colleagues which had been similarly applied in an adapted anoscopy approach by their team. A lavender top vacutainer tube was carefully placed into the vagina after removing the rubber top. The glass tube was secured with one of the operator's hands while the hysteroscope was placed into the tube to the apex. While slowly withdrawing the scope, the cervix and entire circumferential vaginal canal was able to be visualized completely. No distension media was required. No additional lesions, sources of bleeding or lacerations were found. The procedure was completed, and the patient was discharged from the hospital post-operatively without complications. <h3>Comments</h3> In the above described case, routine vaginoscopy during exam under anesthesia was indicated for full evaluation after a penetrating straddle injury. Although many techniques have been described for this simple procedure, functional cystoscope or hysteroscope equipment is required which may produce technical challenges if being performed during an emergent surgery. A clear plastic tube placed in the rectum is used in pediatric anoscopy, but the use of a glass specimen tube inserted partly into the rectum is an available inexpensive modification. The vaginal length in prepubertal girls measures 4 to 5 cm, and increases to 8 cm in length in the peri-menarchal period. A vacutainer or glass specimen tube was available in 7 and 10 cm length, is around 1 cm in diameter, and fits atraumatically into the prepubertal vaginal canal. The described surgical technique in this clinical case by hysteroscopic visualization of the tissue through a transparent glass tube proved to be a fast, effective, and inexpensive modification for routine vaginoscopy. This technique may not be generalizable to adolescents or older women with larger vaginal sizes due to inadequate distention with the available tube sizes.