Major Gynaecological Surgery Research Articles

Factors Associated with Prolonged Ambulatory Surgery Stay for Major Gynecologic Surgery

Study Objective To identify factors associated with overnight admission after major minimally invasive gynecologic surgery, and create a prediction model. Design Retrospective cohort study. Setting Academic Medical Center. Patients or Participants Patients undergoing major minimally invasive surgery by a single surgeon between 2018 and 2020. Interventions Pre-operative patient characteristic data and peri-operative data were collected retrospectively. Logistic regression analysis of factors associated with same-day discharge versus overnight admission was performed. Measurements and Main Results 461 major minimally invasive cases were identified, of which 425 cases were considered eligible for ambulatory surgery discharge and were included in the analysis. 279 (65.6%) patients were discharged same-day, and 146 (34.4%) were admitted.Patients with later procedure start times (OR 0.9), cancer pathology (OR 0.4), high four-hour postoperative pain scores (OR 0.8), and presence of urinary catheter in the recovery room (OR 0.1) had significantly decreased likelihood of same-day discharge. A prediction model including nineteen patient characteristic and peri-operative variables explained 57.8% of the variability of whether or not patients were admitted after surgery. The model correctly predicted 69.3% of admissions and 90.1% of same-day discharges, giving an overall prediction rate of 82.4%. 7 (2.5%) patients discharged same-day and 4 (2.7%) patients admitted returned to the emergency room within 30 days; 1 (0.4%) patient discharged same-day and 4 (2.7%) patients admitted had a readmission within 30 days. Conclusion Peri-operative factors such as surgery start time, postoperative pain level, presence of urinary catheter in the recovery room as well as diagnosis of malignancy are predictive of overnight admission. Postoperative hospital stay does not improve 30-day readmission rates or the number of ER visits after the discharge. Knowledge of factors associated with prolonged stay after major ambulatory surgery can aid in counseling and peri-operative planning.

The Impact of an Enhanced Recovery after Surgery (ERAS) Protocol Implementation in a Community-Based Hospital.

Study Objective Does ERAS reduce opioid usage without adversely impacting patient satisfaction, length of stay (LOS) readmissions and complications? Design Retrospective quality care improvement study Setting Intercity community Hospital Patients or Participants Patients undergoing major Gynecologic surgery by Gynecologic oncology service. Interventions: ERAS protocol. For Minimally invasive Surgery (MIS) cases, gabapentin 24 hours prior to surgery was started, and was continued for 2 days postoperatively. Multimodal analgesia was used in the postoperative period. Measurements and Main Results Post ERAS implementation cases were compared with a cohort of consecutive patients undergoing major surgery 2 years prior to implementation. No significant differences in demographic, surgical or clinical characteristics were demonstrated. 174 cases were completed by MIS. LOS was similar before and after implementation (2.82 vs 2.71, p= 0.339), open cases had a longer LOS before ERAS (> 4 days in 16 (80%) vs 12 (63%, p=0.122). LOS for MIS before and after ERAS was no different (75.6% pre ERAS vs 78% after ERAS, p=0.339). After ERAS protocols, there was a significant decrease in amount of overall opioid usage (90 vs 61 P Conclusion ERAS was effective in decreasing the amount of opioid use at a large intercity community hospital.

Outcomes after implementation of an enhanced recovery pathway after major gynecologic oncology surgery at a tertiary care center

Objective: The aim of this study was to examine the impact of an enhanced recovery after surgery (ERAS) pathway in patients undergoing exploratory laparotomy because of suspected or known gynecologic malignancy at a tertiary care center.

Sexuality in Women After Hysterectomy

Hysterectomy is the most common major gynecological surgeries, with up to 39,4% women will experience it during her lifetime. This procedure can be stressful for women as half of them will experience mild to severe physical and psychological complications. Uterus removal is often associated with de-feminization, castration, being disabled and loss of wholeness which may alter body image and self-esteem, ultimately lead to depression. Most women are anxious on how hysterectomy affect their sexuality, but only few feel comfortable discussing this essential matter to health professionals. The evaluation and management of sexual dysfunction had been the traditional province of psychiatrist. Psychiatrists should fulfill their competencies by updating knowledge on sexuality and sexual dysfunction, improving communication skill, being comfortable with own sexuality and discussing sexuality with other. Pharmacotherapy, relaxation techniques, behavior therapy, group therapy, analytical oriented sex therapy, dual-sex therapy and other techniques or exercises are some modalities option which may help women with sexual difficulties post-hysterectomy.

Postoperative Urinary Retention after Benign Gynecologic Surgery with a Liberal versus Strict Voiding Protocol

Surgeons employ various methods for evaluating what is considered a common occurrence after gynecologic operations, postoperative urinary retention (POUR). Few have reported the incidence of POUR with a liberal voiding protocol (no requirement to void before discharge). The primary objective of this study was to evaluate the risk of POUR after benign gynecologic surgery, comparing a liberal voiding protocol with more strict voiding protocols. Secondary outcomes included length of hospital stay (LOS) and urinary tract infection (UTI). Retrospective cohort study. Quaternary-care academic hospital in the United States. Patients undergoing hysterectomy or myomectomy at Cedars-Sinai Medical Center from August 2017 through July 2018 (n = 652). Cases involving incontinence operations, correction of pelvic organ prolapse, malignancy, or peripartum hysterectomy were excluded. Hysterectomy, myomectomy. POUR, defined as the need for recatheterization within 24 hours of catheter removal, along with UTI and LOS were compared between liberal and strict voiding protocols. A subgroup analysis was performed for those undergoing minimally invasive surgery (MIS). A total of 303 (46.5%) women underwent surgery with a liberal postoperative voiding protocol and 349 (53.5%) women with a strict voiding protocol. Overall, the incidence of POUR was low at 3.8% and not different between the groups (2.6% liberal vs. 4.9% strict, p = .14). UTIs also occurred infrequently (2.8% overall, 2.6% liberal vs. 2.9% strict, p = .86). Similar results were seen specifically among those who underwent MIS: POUR (3.7% overall, 2.8% liberal vs. 5.3% strict, p = .17) and UTI (3.3% overall, 2.4% liberal vs. 4.7% strict, p = .28). The median LOS (interquartile range) was much shorter for MIS patients with a liberal voiding protocol (median 15 hours overall [interquartile range 15 hours], 9 [4] hours liberal vs. 36 [34] hours strict, p <.01). Among those discharged the same day (72.6% of the MIS cases), patients with a liberal voiding protocol had a significantly shorter LOS than those with strict (mean [standard deviation] 9.4 [2.5] hours vs. 10.6 [35] hours, p <.01). Postoperative complications occurred less frequently in those with MIS procedures (11.8% in MIS vs. 20.2% in laparotomies, p <.01) and those with liberal voiding protocols (11.2% liberal vs. 16.9% strict p = .04). Overall, POUR occurs infrequently after major benign gynecologic surgery and does not differ between those with liberal and strict voiding protocols. Our data suggest that same-day discharge after MIS hysterectomy and myomectomy without a requirement to void does not increase the risk of POUR and shortens LOS. Eliminating voiding protocols after these procedures may facilitate greater efficiency in the postanesthesia recovery unit and may contribute to enhanced recovery after surgery protocols.

Experience of Palestinian Women After Hysterectomy Using a Descriptive Phenomenological Study

Background: Universally, hysterectomy is considered as the second most frequent surgery after cesarean section performed on women in the reproductive age. After a hysterectomy, women no longer have menstrual periods, so they cannot become pregnant. Like most other countries, hysterectomy is the most common major gynecological operation in Palestine. However, the psychological, physical, and sexual consequences of hysterectomy are conflicting, and the findings are mixed. While some studies report that patients experience more significant improvement in their mental health, sexual desire, and overall satisfaction, other studies show that patients report various adverse outcomes, with detrimental effects on sexual functioning being the main concern. Objective: This study aimed to describe women's experiences of hysterectomy and identify their fears, concerns, and what coping mechanisms do they adopt to enhance the quality of their lives. Methodology: Qualitative descriptive phenomenological research design was used in this study. The study aims to gain insight into the experiences of fifteen patients after hysterectomy using semi-structured in-depth interviews. The interview was conducted in both private and governmental hospitals using purposeful sampling. Results: Giorgi's phenomenological analysis process was used as a tool for analyzing data. Analysis of the interview transcripts led to five themes, including a total of eighteen subthemes. The first theme is physical change that has pain, insomnia, eating habits, and immobility as subthemes. The second theme is psychological changes with depression, de-socialization, anxiety, and aggressiveness as its subthemes. The third theme is defense mechanisms with praying, listening to music, reciting the Holy Quran, walking, and sports as subthemes. The fourth theme is self-esteem and body image with confidence, appearance, and concerns as subthemes. Lastly, the fifth them is sexuality with excitement and sexual pattern as subthemes. Conclusion: The results of this study demonstrated that hysterectomy had significant adverse effects on patients' body image, and self-esteem. Moreover, the study identified common meanings and themes associated with hysterectomy stressors. These are difficulties or limitations in physical and psychological aspects perceived by patients after hysterectomy. The health care provider must be aware of these potentially problematic issues to provide competent health care.

A Comparative Study of Single Dose Dexamethasone versus Ondansetron for control of Post Operative Nausea and Vomiting after High-Risk Surgeries

The occurrence of postoperative nausea and vomiting is generally associated with anesthesia and surgery. The problem is compounded in cases of high-risk surgeries where the incidence is quite high. The present study was designed to compare the efficacy of Dexamethasone and Ondansetron. Methods: This study was undertaken at the Prathima Institute of Medical Sciences, Naganoor, Karimnagar. In this randomized, open clinical trial, we studied 80 ASA grades I to 1V patients of age group 20-60 years undergoing Laparoscopic Laparotomy, Major Gynecological surgeries, Renal, Shoulder and ENT surgeries under general anesthesia. The patients were randomly divided into two groups, Group I and Group II, each consisting of 80 patients. Group I received 4mg dexamethasone intravenous (IV) just after intubation and group II received 4mg Ondansetron intravenous (IV), just before extubation. Results: The most common age group was 50 – 59 years which had n=45(28.1%) patients out of which group I was n=24(15%) patients and n=21(13.1%) patients. The next common age group was 20 – 29 years out of which n=23 (14.4%) and n=18(11.2%). ondansetron group, early nausea is mild in 6.9%, moderate in 3.8%, and severe in 1.2% of patients. Whereas in the dexamethasone group early nausea is mild in 6.2%, moderate in 4.4%, severe in 1.9% of patients. In the ondansetron group, late nausea is mild in 9.4%, moderate in 3.8%, and severe in 0.6% of patients. Whereas in the dexamethasone group late nausea is mild in 7.5%, moderate in 4.4%, severe in 0.6% of patients. In the ondansetron group, early vomiting is mild in 5.0%, moderate in 0.6%, and severe in 0.6% of patients. Whereas in the dexamethasone group early vomiting is mild in 4.4%, moderate in 1.2%, severe in 0.6% of patients. Conclusion: dexamethasone given intravenously just after intubation and ondansetron given intravenously just before extubation are safe and have similar efficacy in postoperative nausea and vomiting after elective surgeries under general anesthesia having a high risk of PONV

Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years' experience in a single institute.

BackgroundHysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital.MethodsWe retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. ResultsA total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). ConclusionMinimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery

IntroductionDescribing the surgical and oncological outcome of bladder-preserving ureter reconstruction (BPUR) with segmental ureteral resection after major gynecologic surgery. Matherials and methodsPatients with BPUR admitted at a single institution between March 2012 and July 2018 were retrospectively analyzed. Surgical and oncological data were assessed. ResultsForty-six women with gynecologic tumors involving the ureter were treated with BPUR. R0 resection was achieved in 40/46 patients (86.9%), while pathologic margins were microscopically positive in 6 women (13.1%). Overall, 12 women (26.0%) received radiotherapy before surgery: among them, 8 patients received neoadjuvant chemoradiotherapy. Twenty-six women underwent BPUR during primary surgery, whereas 20 (43.4%) required BPUR upon recurrence. Twenty-six patients (56.2%) were found to have hydronephrosis at pre-operative workup. The psoas bladder hitch was the most common procedure performed for urinary reconstruction (63%) with respect to direct reimplantation (37%). Fourteen patients (14/46 = 30.4%) experienced urological complications. Urinary leakage occurred in 9 patients (19.5%), specifically: 5 uretero-vaginal fistula, 3 uroperitoneum, 1 uretero-enteral fistula. There were 3 cases (6.5%) of hydronephrosis at the side of ureteroneocystostomy and 2 cases (4.3%) of unilateral renal impairment requiring nephrectomy. At multivariate analysis only pre-operative radiotherapy (p = 0.047) and a history of pelvic irradiation (p = 0.025) were independently associated with an increased risk of developing severe urinary complications. ConclusionsBPUR is feasible in gynecologic cancer with invasion of the urinary tract. However, since a slight increase of post-operative urological complications was observed in the previously irradiated fields, a personalized surgical planning is recommended for these women in the next future.

3:36 PM Abstract No. 277 First-in-human evaluation of an absorbable vena cava filter for the prevention of pulmonary embolism

To prospectively evaluate an absorbable vena cava filter for short-term protection from pulmonary embolism in humans for the first time. This was a prospective, single-site, single-arm clinical trial of 8 subjects with temporary risk of DVT and/or PE conducted at Hospital Universitario, Monterrey, Mexico under Institutional Review Board (IRB) and COFEPRIS approval. The primary objective was to evaluate the safety of the first absorbable IVC filter in a limited number of humans. Absorbable filters (Adient Medical, Pearland TX) were placed prophylactically in 7 subjects prior to major orthopedic (5) and gynecological (2) surgeries, while one was placed following a DVT. The mean Caprini VTE risk score was 7.8 ± 1.8, all within the highest DVT risk category (≥ 5). All subjects underwent computerized tomography (CT) cavography and abdominal radiography prefilter, 5, 11, and 36 weeks following filter placement to assess filter migration, embolization, perforation, and caval thrombosis and stenosis. PE was assessed prefilter and 5 weeks following filter placement via CT angiography. No pulmonary embolism was symptomatically reported throughout the study or detected at the planned 5 week assessment. No filter migration was detected throughout the study based on the fixed location of the cylindrical radiopaque markers (located at the filter apex) relative to the vertebral bodies at the follow-up visits. No filter embolization or perforation was detected, and no stenosis was observed at the follow-up visits. A thrombus measuring approximately 7-mm diameter x 20 mm long was observed shortly after deployment in the filter basket of the therapeutic subject with DVT history. Such thrombus was not apparent in the filter basket at the subsequent 5-week follow-up, nor was a PE detected. Overall throughout the study, no filter-related adverse events were reported. Non–filter-related adverse events included mild influenza and septic arthritis prior to a planned total knee arthroplasty. Implantation of an absorbable vena cava filter proved safe in a limited number of human subjects. No pulmonary embolism or filter-related adverse events were observed.

Enhanced Recovery After Surgery in Pediatric and Adolescent Gynecology: A Pilot Study.

Enhanced recovery after surgery (ERAS) protocols have been successfully implemented in adult gynecology as well as adult and pediatric colorectal and urologic surgery with reduction in narcotic use, complications, return to the system (RTS), length of stay (LOS), and improved patient satisfaction. There are no studies evaluating the use of ERAS in pediatric and adolescent gynecology (PAG). The goals of this study are to present initial patient outcomes using ERAS in PAG patients undergoing intra-abdominal gynecologic surgery to prove efficacy, patient satisfaction, and decreased narcotic use. As a quality improvement measure in perioperative care, an ERAS protocol including preoperative, intraoperative, and postoperative components and a follow-up patient telephone call for pain assessment was implemented for all intra-abdominal gynecologic procedures. A retrospective study on implementation of ERAS components, outcomes, and patient satisfaction was then performed in participants meeting inclusion criteria. Large academic children's hospital. Patients <25years of age who underwent laparoscopic (LSC) or open abdominal (XLAP) gynecologic surgery using an ERAS protocol by the PAG service over a 12-month period. An ERAS protocol including preoperative, intraoperative, and postoperative components and follow-up patient telephone call for pain assessment was implemented for all major gynecologic surgeries performed by the PAG service. Patient satisfaction with the perioperative ERAS protocol along with components including pain management, narcotic use, LOS, RTS, and postoperative complications for various intra-abdominal gynecologic procedures. A total of 40 participants met inclusion criteria for the study. Thirty-four (85%) participants underwent LSC procedures and six (15%) underwent XLAP. Of the LSC patients, 95% were discharged on postoperative day 0, and all XLAP patients and one LSC patient were discharged on postoperative day 1. In all, 95% of patients were discharged from the hospital requiring only non-narcotic ERAS medications. There were no readmissions or postoperative complications. All patients were satisfied with their postoperative pain control at their follow-up telephone call and clinic visit. Implementation of a pediatric-specific ERAS protocol in children and adolescents undergoing gynecologic surgery is feasible and safe, and leads to less narcotic use without an increase in complications or decrease in patient satisfaction.

Comparison of thoracic paravertebral block and transversus abdominis plane block for postoperative analgesia in major gynecologic surgery: A single blind randomized controlled clinical trial

IntroductionPatients after major gynecologic surgeries experience moderate to severe pain, which needs pharmacological intervention. Different regional blocks are now a days introducing as components of multimodal analgesia for pain management. Even though transversus abdominis plane block and paravertebral block were described for postoperative analgesia in abdominal surgeries, data comparing these blocks for gynecologic surgery is limited. ObjectivesThe aim of this single blind randomized controlled trail was to compare thoracic paravertebral block and transversus abdominis plane block for postoperative analgesia in patients underwent gynecologic surgery under general anesthesia. MethodologyThirty four patients with American society of anesthesiologists physical status I and II, age between 18 and 65 years underwent gynecologic surgery under general anesthesia were randomly allocated in thoracic paravertebral group or transversus abdominis plane block group. Patients' pain intensity with numerical rating score, time to first analgesic time and total rescue analgesic/tramadol consumption were documented by data collectors who were unaware of the block done for the patents during the first 24 ours postoperatively. ResultsTime to first analgesic request was lower in thoracic paravertebral group than transversus abdominis plane group but not statistically significant (p = 0.057). Median numerical rating scale score was significantly lower in thoracic paravertebral group than transversus abdominis plane group at post anesthesia care unit admission (p = 0.016). Time taken to perform the block was significantly higher in thoracic paravertebral group than transversus abdominis plane group (p < 0.001). ConclusionBoth thoracic paravertebral block and transversus abdominis plane block were effective for postoperative analgesia in women underwent gynecologic surgery under general anesthesia. Although thoracic paravertebral block appeared to be as effective as transversus abdominis plane block, it took longer time to perform the block.

Comparison of prophylactic dexamethasone, metoclopramide, and combination of dexamethasone and metoclopramide for prevention of post-operative nausea and vomiting for major gynaecological surgery in Hawassa university compressive specialized hospital, Ethiopia, 2019

BackgroundPostoperative nausea and vomiting is a common postoperative unpleasant and distressful experience among major abdominal gynecological surgery with incidences of up to 54% and 71% vomiting &nausea respectively. PONV is primarily occurs within 24 h can lead to significant morbidity, unexpected hospital admission of surgical outpatients by reducing patient comfort, delayed discharge from the hospital, and an increase in costs. ObjectiveTo compare the effectiveness of dexamethasone, metoclopramide and combination of them in prevention of post-operative nausea and vomiting in patients undergoing gynaecological surgery. MethodsInstitutional based Prospective randomized control trial study was conducted Hawassa comprehnsive specialized hospital from March 2018–February 2019. This study was conducted on female patient age 18–65 years. Data was collected by pretested and self-designed structured questionnaire and analysed by using computer software SPSS version 22.data were evaluated using one way ANOVA test. Categorical data was analysed with the Chi-Square test and P- Value of less than 0.05 was significantly associated with outcome variable. ResultTotal incidence of PONV during 4–12 h was 25% in the dexamethasone group, 53% in the metoclopramide group, 18.8% in the dexamethasone plus metoclopramide group (p = 0.007). There was significant difference in incidence of nausea at 4–12 h (p = 0.011) and 12–24 h (p = 0.043). The overall incidence of PONV was 31.3%, 65.6% &28.1%of dexamethasone, metoclopramide and combination of them respectively which was lower in dexamethasone & combination (p = 0.003). Total antiemetic drug over 24 h was significantly lower in the dexamethasone and combination groups than the metoclopramide groups which were, 28.1%, 25% and 62.5% respectively (p = 0.003). ConclusionsWe conclude that prophylactic Dexamethasone and Dexamethasone plus 10 mg Metoclopramide was found more effective in preventing PONV and decreasing the requirement of rescue antiemetic than Metoclopramide & comparable effectiveness between dexamethasone and combination in prophylaxis of PONV.

Trends in vaginal hysterectomy in a Nigerian teaching hospital: A 14-year review

Background: The procedure of vaginal hysterectomy is a fast disappearing art. This study looks at 14 years' experience of vaginal hysterectomy in Ile-Ife, Nigeria. Objectives: To determine and compare the rate, indications, and complications of vaginal hysterectomy over a 14-year period at Ile-Ife, Nigeria. Methods: The medical records of patients managed with vaginal hysterectomies performed from 1st January 2005 to 31st December 2018 were reviewed. The demographics and indications for vaginal hysterectomy were extracted. Data were analyzed using Statistical Package for Service Solutions – IBM version 22. Frequencies and percentages were calculated and associations compared where applicable using Chi-square with level of significance set at Results: Pelvic organ prolapse accounted for 0.8% of gynecological admissions and vaginal hysterectomy accounted for 2.3% of major gynaecological operations. The mean age was 66.1 ± 9.2 years with a mean age of menopause of 15.2 ± 7.1 years. The mean parity was 6.2 ± 1.6. Pelvic organ prolapse was the commonest indication. The mean blood loss at surgery was 314.2 ± 184.8 ml. The modal post-operative complication was post-operative anemia, and hypertension was the commonest comorbidity. The mean duration of surgery was 3 ± 0.9 h and the mean duration of admission was 5.4 ± 2.7 days. Conclusion: The rate of vaginal hysterectomy is on the decline. This may be due to case under reporting, limiting of family size, or low uptake of farming occupation in our society.

Paradigm Shift in Gynecological Surgeries Over Eight Years in Dhulikhel Hospital.

Introduction: One of the greatest achievements in the surgical field is the paradigm shift from opensurgery to minimal invasive surgery. Hysteroscopy, laparoscopy, laparoscopy-assisted vaginal hysterectomyand total laparoscopic hysterectomy are frequently performed minimal invasive gynecological surgeries.These surgeries are being regularly performed in Dhulikhel hospital. This study aims to review thechanges in surgical approaches in the field of gynecological surgeries in this institute. Methods: This was aretrospective study of changes in surgical approaches from conventional to minimal invasive surgery in thefield of gynecological surgeries from 2010 to 2018. Demographic characteristics of patients and indicationfor various minimal invasive surgeries were compared over this time period. Results: There were significantchanges in surgical approaches from conventional open surgeries to minimally invasive approach throughthe years. There was no obvious difference in demographic characteristics of the cases and the indications forhysterectomy and endometrial sampling were comparable. Conclusion: There was definitely paradigm shiftin conventional method to minimal invasive methods for major gynecological surgeries like hysterectomy,ovarian cystectomy, salpingectomy for ectopic pregnancy and endometrial samplings.

Association of elevated pre-operative HbA1c and post-operative complications in patients undergoing gynaecological oncology surgery

HbA1c testing provides average blood glucose control, an elevated result may be associated with adverse post-operative outcomes. Our objective was to evaluate the association between elevated pre-operative HbA1c and post-operative complications in patients undergoing major gynaecological oncology surgery. HbA1c was measured pre-operatively in 364 patients. We identified 65 (16%) patients at risk of developing diabetes with borderline HbA1c measurements. Patients with borderline HbA1c (42–47 mmol/mol) had almost double the incidence of infections compared to patients with normal HbA1c (15.8% vs. 6.5%, p=.038). There were significantly less infections between patients with a normal HbA1c (<42 mmol/mol) and those with an HbA1c of over 42 mmol/mol (6.5% vs. 22.8%, p<.05). There was an association between elevated HbA1c and infective complications especially in patients with a borderline HbA1c. It is suggested that knowing HbA1c status, intervention can be made to prevent post-operative infective complications and improve outcomes. Impact statement What is already known on this subject? Obesity is a common risk factor for gynaecological cancer and elevated HbA1c. Chronically elevated HbA1c may lower immunity. An association has been shown previously between elevated HbA1c and post-operative complications. What the results of this study add? This study examined infective complications in patients undergoing gynaecological surgery; showing that patients with a borderline HbA1c (42–47 mmol/mol), especially those with a diagnosis of diabetes to be most at risk. This suggests that pre-operative HbA1c should be used routinely to guide care rather than diabetic status alone to prevent post-operative infections. What the implications are of these findings for clinical practice and/or further research? More research needs to be carried out to find the optimal pre-operative HbA1c targets to reduce post-operative infection rates. Work needs to be done in conjunction with general practitioners to help patients to reduce their HbA1c prior to treatment.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery: Erratum.

Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effot to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.

The Statistical Analyses Of The Study "Sufentanil Sublingual Tablet System (SSTS) For The Management Of Postoperative Pain After Major Abdominal And Gynecological Surgery Within An ERAS Protocol: An Observational Study" [Response To Letter

The Statistical Analyses Of The Study "Sufentanil Sublingual Tablet System (SSTS) For The Management Of Postoperative Pain After Major Abdominal And Gynecological Surgery Within An ERAS Protocol: An Observational Study" [Response To Letter] Stefano Turi, Francesco Deni, Gaetano Lombardi, Marilena Marmiere, Francesco Giuseppe Nisi, Luigi Beretta Dipartimento di Anestesia, Ospedale San Raffaele, Milano, ItalyCorrespondence: Stefano TuriDepartment of Anesthesiology, Vita-Salute, University, San Raffaele Hospital, Via Olgettina 60, Milan 20132, ItalyTel + 39 02 2 643 2656Email turi.stefano@hsr.it Dear editor We thank Wang and Miao1 for their interest in our recent publication2 and the appreciation of our work. We agree with them on the need of using repeated-measures analysis to evaluate pain intensity at different timepoints. We acknowledge that, for the sake of brevity, our manuscript did not properly clarify the statistical methods used for the analysis and we take this opportunity to better explain them. We performed a repeated measure analysis of variance (ANOVA) to compare pain intensity on different time points. The analysis resulted statistically significant (p

Impact of safety protocol in an ambulatory surgical setting vs a hospital setting for laparoscopic-assisted myomectomy (LAM)

Ambulatory surgery center (ASC) for major gynecological surgery improves efficiency and decreases cost compared to a hospital setting. Protocols to ensure safety when performing major gynecologic surgeries are critical in the ASC setting. The objective of this study is to assess whether protocols do ensure safety when performing major gynecological surgeries such as laparoscopic-assisted myomectomy (LAM) in a high-volume ASC and compare it with protocols and outcomes in a hospital setting. This is a descriptive / retrospective study. This paper descriptively outlines the similarities and differences of a surgical safety protocol in an ambulatory surgical center compared to a hospital setting. Furthermore there is retrospective analysis of LAM outcomes that are commonly considered as safety standards in both settings including intraoperative and postoperative complications. The protocols were similar with regards to preoperative patient selection and checklist, surgical precautions including prevention of retained surgical items, DVT prophylaxis, infection control, surgical wound classification, vaginal and genital antisepsis for the surgical patient, postoperative care in PACU and discharge criteria for surgical management. The major preoperative differences from hospital protocol were transfusion criteria preoperatively. In the ASC, a cut-off of 9.0 g/dl was used, and a cut-off of < 7.5 g/dl was used in the hospital setting. LAM cases are only scheduled as morning cases. 23 hour observation is available at ASC. Additionally myomectomy patients at the ASC have ISTAT (blood analysis system to check Hemoglobin/Hematocrit) prior to procedure and at 1 and 2 hours after the procedure in the PACU to detect any signs of bleeding. Any patients that did require blood transfusion postoperatively were transferred to the local hospital from the ASC. There were 588 patients that underwent LAM at the ASC compared to 228 patients at the hospital. There was no significant difference in case complexity factors between settings including BMI, number of previous abdominal and pelvic surgeries or other comorbidities. Intraoperative complication rate was 3.4% (95% CI 1.8-5.0) at the ASC compared to 4.9% (95% CI 1.7-8.1) , p = 0.4430. There were no significant differences in postoperative complications between the ASC and the hospital setting including infections and thromboembolic events. Blood transfusion was required in 1.7% of the cases at ASC compared to 8.8% at the hospital setting. The estimated blood loss and average fibroid weight were not statistically different between the two groups. The LAM safety protocol at a free-standing ASC allows for patient complication outcomes that are comparable to an in-hospital setting without apparent limitations in patient complexity.

The statistical analyses of the study "Sufentanil Sublingual Tablet System (SSTS) for the management of postoperative pain after major abdominal and gynecological surgery within an ERAS protocol: an observational study"[Letter

The statistical analyses of the study "Sufentanil Sublingual Tablet System (SSTS) for the management of postoperative pain after major abdominal and gynecological surgery within an ERAS protocol: an observational study"[Letter