Effect of Fellowship-Trained Surgeon Involvement on Hysterectomy Outcomes in Morbidly Obese Patients

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 tasks. In the current study, there was no such correlation with the peg transfer task, likely due to familiarity of the task from the prior study. The current study is a continuation of an ongoing quality initiative to establish a validated simulation program for maintenance of credentials among Ob-Gyn surgeons. Future studies will compare prior simulation scores with validated surgical assessments, operative metrics, and surgical outcomes. Open Communications 15: Basic Science/Research/Education (12:00 PM − 12:45 PM) 12:14 PM Effect of Fellowship-Trained Surgeon Involvement on Hysterectomy Outcomes in Morbidly Obese Patients Whitley J,1,* Moore KJ,2 Louie M3. 1University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC; 3 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Study Objective: To assess the effect of fellowship-trained surgeons (FTS) on hysterectomy-related complications in morbidly obese patients. Design: Retrospective cohort study Setting: Tertiary-care, academic medical center with generalist obstetricians/gynecologists, gynecologic oncologists, urogynecologists, and minimally invasive gynecologic surgery trained surgeons Patients or Participants: Patients with BMI > 40 kg/m2 who underwent any route of hysterectomy between 4/2014 and 3/2018 were eligible for inclusion. 225 patients were randomly selected, excluding patients with malignancy or bariatric surgery. Interventions: 105 patients who underwent hysterectomy with a FTS were compared to 120 patients with no FTS. Data was collected by chart review and polytomous logistic regression was used for analysis. Measurements and Main Results: Patients in the FTS group were more obese (BMI 46.7 v. 45.0, P=0.01), had a higher prevalence of obesity-related medical comorbidities (80% v. 55%, P<0.01), and had greater specimen weight (649.9 g v. 320.7 g, P=0.01). ASA class and history of previous abdominal surgery were similar between groups. There were more abdominal hysterectomies (15.2% v. 6.7%, P=0.04) and operative time was longer (230.2 minutes v. 184.5 minutes, P<0.01) in the FTS group. We found no difference in the odds of any complications within 30 days of hysterectomy between groups. After adjusting for factors representing case complexity including hysterectomy route, operative time, medical comorbidities, and specimen weight, there remained no difference despite a suggestion of lower odds of any complication (aOR 0.88; 95% CI 0.39, 1.98) and intraoperative complications (aOR 0.43; 95% CI 0.10, 1.83) in the FTS group. Conclusion: In morbidly obese patients, hysterectomy by fellowship trained surgeons was not associated with a difference in 30-day complications. It is possible that in this high-risk cohort, there are small differences in outcomes, which we are unable to detect. Open Communications 15: Basic Science/Research/Education (12:00 PM − 12:45 PM) 12:21 PM Hysterectomies Completed in General Gynaecology: Can We Predict Likelihood of a Surgical Complication? Shirreff L,1,* Mathews A,1 Shapiro J,1 Cipolla AR,2 Lee SK,3 Po L,4 Murji A5. 1Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada; 2Obstetrics and Gynaecology, Trillium Health Partners, Toronto, ON, Canada; 3Obstetrics and Gynaecology, North York General Hospital, Toronto, ON, Canada; 4Obstetrics and Gynaecology,

S59 Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 5Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada *Corresponding author. Study Objective: To determine hysterectomy complication rate and patient, surgical and provider factors associated with complications. Design: Retrospective review Setting: 5 Toronto hospitals Patients or Participants: Patients undergoing hysterectomy from July 2016-December 2017 Interventions: Hysterectomy procedure Measurements and Main Results: Retrospective review of Generalist hysterectomies at 5 Toronto hospitals from July 2016 to Dec 2017. Data was extracted from health records coding (ICD-10) and electronic medical records. Complications (in-hospital to 30 days of discharge) were classified using Clavien-Dindo Scale. Patient characteristics (BMI, anemia status), surgical factors (technicity, uterine presence of endometriosis and adhesions, uterine weight) and provider characteristics (case volume) were obtained. Logistic models were used to evaluate variables associated with complications. 1328 hysterectomy cases were performed by 67 surgeons over 1.5 years. The 294 recorded complications were classified as: 119 (40%) Grade 1, 102 (35%) Grade 2, 12 (4%) Grade IIIA, 61 (21%) Grade IIIB. Presence of endometriosis increased odds of any complication (OR 1.87, 95%CI 1.053.35, p=0.035). For every 100g increase in uterine weight, odds of ≥ Grade II complication increased by 4.5% (95%CI 0.3% - 9.4%, p=0.035). Low volume surgeons (≤1 hysterectomy/month) had higher unadjusted complication rate (28.6% vs 15.3%, p=0.01). After adjusting for case complexity (composite score incorporating BMI, presence of adhesions, endometriosis and uterine weight) and technicity, low volume surgeons had 2.21 OR (95% CI 1.08 − 4.52, p=0.03) of having ≥ Grade II complication. Conclusion: Endometriosis and uterine weight increase risk of hysterectomy complications. Low volume surgeons perform more challenging hysterectomies and have lower technicity rates. After adjusting for patient and surgical factors, low volume surgeons have higher odds of complications. Open Communications 15: Basic Science/Research/Education (12:00 PM − 12:45 PM) 12:28 PM Post-Operative Opioid Prescribing and Consumption Patterns After Hysterectomy: A Prospective Cohort Study McEntee K,* Crawford K, Wilson M, Nejad B, Waetjen LE. OBGYN, UC Davis Medical Center, Sacramento, CA *Corresponding author. Study Objective: To examine opioid prescribing and consumption patterns after hysterectomy and whether a brief pre-operative survey predicts post-operative opioid consumption. Design: Prospective cohort study; duration of study participation 3 weeks. Setting: Single university medical center. Patients or Participants: From February 2018 to January 2019, we enrolled 99 women undergoing hysterectomy for benign, non-obstetric indications. Interventions: Pre-operatively, participants reported their baseline pain score (0-10 scale). During the third post-operative week, they completed a telephone interview, including direct count of remaining opioid pills. We assessed factors associated with number of pills taken equivalent to oxycodone 5mg. Measurements and Main Results: 81 participants completed the postoperative survey after hysterectomy: robotic assisted (n=35), conventional laparoscopic (n=29), vaginal (n=9), or abdominal (n=8). On average, participants took 14.8 pills (std 13.2), were prescribed 27.8 pills (std 11.3), and took 50% of their prescription (std 36.4). Mean duration of use varied significantly by route, however amount taken did not. Higher baseline pain scores and larger prescriptions were associated with more pills taken. For