1569 The Efficacy and Safety of Long-Term Management of Uterine Fibroids with Ulipristal Acetate

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231 Study Objective: We present a case study in improving quality metrics with the Kaiser Permanente Minimally Invasive Hysterectomy Initiative to address the high rates of abdominal hysterectomies. Design: Quality Improvement Project. Setting: Route of hysterectomy (abdominal, laparoscopic, vaginal, robotic). Patients or Participants: 31,385 patients who underwent surgical hysterectomy at Kaiser Permanente Northern California between 2008-2015. Interventions: We initiated a four-pronged quality improvement program to increase the rate of minimally invasive hysterectomies, including: 1) Leadership engagement to set goals and achievable targets; 2) Surgeon education and training; 3) Utilization of targeted medical data to track outcomes and drive performance; and 4) Delineation of Obstetrics and Gynecology surgical teams and establishment of criterion-based credentialing. Measurements and Main Results: Total abdominal hysterectomy percentages decreased from 50.5% to 6.9%, and total laparoscopic hysterectomy percentages increased from 21.9% to 61.9%. Robotic hysterectomy percentages only increased from 0.1% to 7.8%, and total vaginal hysterectomy percentages were maintained. Conclusion: Our experience indicates that a quality improvement program to reduce abdominal hysterectomies while improving patient care can be successfully instituted on a large scale with limited reliance on less cost-effective robotic technology. The core aspects of the strategy should be highly incentivized under programs like Medicare Access and CHIP Reauthorization Act (MACRA). Moreover, this model can be used to address other quality issues in gynecologic surgery. It is our hope that the future of gynecologic surgery moves towards such a model that prioritizes optimal patient care. Please note that this abstract includes information that was presented in the paper, “Measuring Quality in Minimally Invasive Gynecologic Surgery: What, How, and Why?” by Abel et. al. in JMIG February 2019. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION D 1569 The Efficacy and Safety of Long-Term Management of Uterine Fibroids with Ulipristal Acetate Kim HG,1 Yang J,1 Na YJ2,*. 1Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Korea, Republic of (South); 2 Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea, Republic of (South) *Corresponding author. Study Objective: To investigate the efficacy and safety of four repeated 12-week courses of 5 mg daily ulipristal acetate for intermittent treatment of symptomatic uterine fibroids. Design: A retrospective, single-center observational study. Setting: A university tertiary referral center. Patients or Participants: One hundred seventy-one premenopausal women with symptomatic uterine fibroids. Interventions: Four repeated 12-week treatment courses of daily 5 mg ulipristal acetate. Measurements and Main Results: After four repeated 12-week courses, uterine bleeding was controlled in 93% of the women receiving 5 mg of ulipristal acetate. The rates of amenorrhea were 83% occurring within 9 days in the majority of patients receiving ulipristal acetate. The median changes in total fibroid volume were −17%. Headache and breast tenderness were the most common adverse events associated with ulipristal acetate but did not occur significantly more frequently. Pain showed marked improvements from screening, even during the off-treatment intervals. The safety profile of ulipristal acetate was confirmed, and repeated treatment courses did not increase the occurrence of adverse reactions. There were no significant changes in laboratory parameters during the study. Conclusion: The results of this study demonstrate the efficacy and further support the safety profile of four repeated 12-week courses of 5 mg daily ulipristal acetate for intermittent treatment of symptomatic uterine fibroids.

S99 Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION E 1612 Comparison of Short Term Outcomes after Laparoscopic Salpingostomy Versus Salpingectomy for the Surgical Management of Ectopic Pregnancy Bouchelion AC,1,* Sheyn D,2 Billow M1. 1OB/GYN, University Hospitals Cleveland Medical Center, Cleveland, OH; 2University Hospitals Cleveland Medical Center/MetroHealth Medical Center, Cleveland, OH *Corresponding author. Study Objective: To investigate the differences in complication rates between laparoscopic salpingostomy and salpingectomy. Design: Propensity score matched retrospective cohort study. Setting: American College of Surgeons National Surgical Quality Improvement Program database. Patients or Participants: Women with surgical management of ectopic pregnancy between 2010-2017. Interventions: Laparoscopic salpingectomy and salpingostomy. Measurements and Main Results: Of 8,092 ectopic pregnancies, 989 were treated with laparoscopic salpingostomies and matched to laparoscopic salpingectomies at a ratio of 1:2 using propensity scores for the likelihood of undergoing salpingostomy. Propensity scores were calculated using preoperative demographic and clinical characteristics. After matching, no significant differences exist between salpingostomy and salpingectomy in preoperative hematocrit (36.1+/-4.4% vs 35.8+/-4.7%, p=0.91), transfusion rate (1.9% vs 2.0%, p=0.19), age (29.8+/-5.7yrs vs 30.1 +/-5.7yrs, p=0.31), and comorbidities (5.8% vs 4.7%). Mean operating times between salpingostomy and salpingectomy showed no difference, (60.7+/-27.2min vs 58.9+/-36.4 min, p=0.78) or conversion to laparotomy (0.2% vs 0.06%, p=0.99). Wound contamination was higher with salpingectomies (3.4% vs 0.02%). The composite complication rate was 10.1%. Postoperative transfusions (6.5% vs 5.8%, p=0.003), reoperation (2.0% vs 0.5%, p<0.001), and readmissions (1.9% vs 0.8%, p=0.005), were more common in the salpingostomy group. There was no difference in infectious, cardiovascular and pulmonary morbidity between groups. After logistic regression, there was a slightly increased risk of complications with salpingostomies compared to salpingectomies (aOR=1.63, 95%CI: 1.36-1.95). Preoperative transfusion was the most significant risk factor of postoperative complications (aOR:8.67, 95%CI:6.32-11.91), followed by American Society of Anesthesiology class ≥3 (aOR:2.75, 95%CI:2.233.37), preoperative WBC ≥10.0 cells/mL (aOR: 2.51, 95%CI:2.13-2.96), and wound class ≥ 3 (aOR:2.54, 95%CI:1.04-6.19). Conclusion: Laparoscopic salpingostomy is associated with higher risk of complications compared to laparoscopic salpingectomy when treating ectopic pregnancies; though the magnitude of this effect is small given the cohort size. This should be considered when counseling patients on salpingectomy versus salpingostomy. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION F 2263 Surgical Experience in Patients with Von Willebrand Disease Diagnosis Operated in a Minimally Invasive Gynecological Surgery Unit Guarin CB,* Villegas-Echeverri JD, Lopez JD, Lopez JD, Arturo V. Risaralda, Clınica Comfamiliar, Pereira, Colombia *Corresponding author. Study Objective: To describe the post-surgical outcome in patients with a history of von Willebrand’s disease undergoing minimally invasive surgery. Design: Case reports, a review of the medical records of the patients who underwent gynecological surgery in the period from 2013 to 2017, reporting the intra and post operative complications.