- Email: [email protected]
Beyond fertility: The safety of ovarian preservation in women with complex endometrial hyperplasia with atypia
82
Abstracts / Gynecologic Oncology 137 (2015) 2–91
Results: Study entry was offered to 22 women, with 19 consenting participants. Mean age was 52 years and 79% were Caucasian. The presentation significantly improved satisfaction with the care provider, with a mean change of 1.4 (standard deviation [SD] 2.1), P = 0.005. Ten of 19 women (53%) indicated maximal satisfaction on both instruments before and after viewing the presentation, with an insignificant mean change in CSQ-8 score 0.3 (SD 1.4), P = 0.13. Mean baseline FACT-G7 was 17.6 (SD 5.5), and this score was not correlated with any of the pre or postpresentation satisfaction measures. Need for timely completion of the nurse education and laboratory portions of the preoperative visit limited the ability to consistently offer study entry. Conclusions: Baseline satisfaction with informed consent before surgery is high. The use of supplemental multimedia is feasible but may be of more benefit at points of care beyond the preoperative encounter. doi:10.1016/j.ygyno.2015.01.199
198 — Poster Session A comparison of epidural analgesia and patient controlled intravenous analgesia on postoperative pain control and recovery parameters in women undergoing laparotomy for gynecologic malignancy K. Tucker, C. Murray-Krezan, C. Muller, T. Rutledge. University of New Mexico, Albuquerque, Albuquerque, NM, USA Objectives: Postoperative pain is a common fear of patients before surgery and adequate pain control is frequently used as a quality measure in surgical care delivery. The question of whether epidural analgesia (EA) provides better pain control than patient-controlled parenteral opioid analgesia (PCA) remains controversial. We sought to determine the effect of EA compared to PCA on postoperative recovery parameters and pain scores. Methods: A retrospective analysis of patients with gynecologic malignancy who had a laparotomy at the University of New Mexico from 2011 to 2013 was performed. Clinical and demographic variables were collected. Descriptive statistics were used to summarize patient characteristics. Linear mixed modeling was used to calculate the least squares mean postoperative pain scores after adjusting for PCA/EA use, demographic characteristics, and repeated measures. Results: A total of 159 patients met study criteria: 80 received EA and 79 received PCA. Hispanics and Native Americans represented 51% of the patients. Ovarian cancer was the most common cancer type (48%). Demographic, preoperative, and intraoperative factors were similar between groups. Patients in the EA group had both a significantly longer length of stay and longer time to Foley catheter removal, first ambulation, and flatus (all P ≤ 0.01). The median length of stay was 5 vs. 3 days in the EA vs. PCA group (P b 0.01). The number of patients with postoperative complications was significantly higher in the EA group (P b 0.01). The EA group reported lower pain scores compared to the PCA group over postoperative days 0, 1, and 2 (P = 0.04). After controlling for postoperative day, the mean pain score (using the Numeric Rating Scale) for the PCA group was 3.4 (95% CI: 3.0–3.8) compared to 2.8 in the EA group (95% CI: 2.5–3.2). Neither ethnicity nor language preference influenced analgesia choice or postoperative pain scores. Conclusions: In this ethnically diverse population, EA provided superior pain control after laparotomy for gynecologic malignancy. However, EA was associated with a longer length of stay, a delayed achievement of postoperative milestones, and a higher prevalence of postoperative complications. The optimal postoperative pain control method that achieves a balance of all pertinent postoperative outcomes remains elusive. doi:10.1016/j.ygyno.2015.01.200
199 — Poster Session Are hospital readmissions an accurate measure of quality cancer care in gynecologic oncology patients? D.N. Pasko, J.D. Boone, E.D. Thomas, W.K. Huh, R.D. Alvarez, C.A. Leath III, J.M. Straughn Jr. University of Alabama at Birmingham, Birmingham, AL, USA Objectives: Readmissions are routinely reported by the University HealthSystem Consortium (UHC) to measure quality care at academic health centers. The objective of this study was to evaluate gynecologic oncology (GO) readmission rates and associated factors to identify potentially preventable readmissions. Methods: A retrospective review of the UHC database for GO readmissions at our institution from January 2011 to July 2014 was performed. Abstracted data included patient and disease characteristics and readmissions defined by UHC criteria. Planned admissions for chemotherapy and radiation therapy were excluded. After independent physician review, reasons for readmissions considered potentially preventable included nausea/vomiting, abdominal pain, and failure to thrive. Outcome measures were 30-day readmission rates and readmission diagnoses. Results: A total of 3781 GO patients were hospitalized. There were 189 readmissions among 159 patients. The mean age was 55 years and mean body mass index was 28.9; 65.6% of the patients were white. Medicare and Medicaid insured 61.4% of patients. A total of 127 patients had a malignant primary diagnosis; the most common were ovarian cancer (52.8%), cervical cancer (22.8%), and uterine cancer (18.1%). Within 21 days of initial admission, chemotherapy was given to 43.2% of patients with ovarian cancer, and 37.9% of patients with cervical cancer had undergone surgery, chemotherapy, and/or radiation therapy 21 days prior to initial admission. Twentysix patients had benign disease and three patients had premalignant disease. The most common 30-day readmission diagnoses were wound complications (23.3%), intestinal obstruction (15.9%), pelvic abscess (9.0%), renal abnormalities (7.9%), nausea and vomiting (6.3%), pulmonary disorders (6.3%), abdominal pain (5.3%), and failure to thrive (5.3%). Thirty-eight of 189 (20.1%) readmissions were considered potentially preventable. Conclusions: A minority of patients readmitted to our GO service had potentially preventable conditions. Most factors associated with readmission cannot be modified, which may indicate that readmission rates are not an appropriate measure of quality care. Based on these data, future quality improvement efforts should be directed toward GO patients who have received therapy before admission and have potentially preventable conditions. doi:10.1016/j.ygyno.2015.01.201
200 — Poster Session Beyond fertility: The safety of ovarian preservation in women with complex endometrial hyperplasia with atypia K.M. Anderson, N.R. Shah, M.A. Davis, L.M. Bean, C.C. Saenz, S.C. Plaxe, M.T. McHale. UCSD Rebecca and John Moores Cancer Center, La Jolla, CA, USA Objectives: To evaluate the safety of ovarian preservation in women undergoing surgical management of complex endometrial hyperplasia with atypia (CAH) and endometrial intraepithelial neoplasms (EIN). Methods: The University HealthSystem Consortium database was queried from 10/2010 to 7/2014 to identify women with CAH and EIN managed with hysterectomy with or without adnexectomy. The risk of occult ovarian malignancy at the time of surgical management was calculated, then further stratified by age b65 or ≥65 years.
Abstracts / Gynecologic Oncology 137 (2015) 2–91
Results: Over a 4-year period, 2730 women were identified with CAH and EIN who underwent any type of hysterectomy. Of these patients, 2315 had concurrent bilateral or unilateral oophorectomy (83.2%). Occult ovarian cancer was found in 27 of these cases, representing an overall risk of 1.2%. Stratified by age, 15 of 1838 women b65 years of age and 12 of 477 who were ≥65 years old had ovarian cancer on final pathology, representing an 0.8% and 2.5% risk of ovarian cancer in these age groups, respectively. We determined the relative risk of occult ovarian malignancy at the time of surgical management of CAH to be 3.1 at age ≥65 vs. age b65 years (relative risk 3.08, 95% CI 1.5–6.5, Fisher's exact test P b 0.006). Conclusions: Conventional management of CAH/EIN in women who have completed childbearing does not differ from that of endometrial cancer, including total abdominal hysterectomy/bilateral salpingooophorectomy. This practice is compelled by the theoretical risk of continued hormonal stimulation of residual endometrial disease, the risk of a synchronous ovarian malignancy, and the risk of metastasis to the ovary. Studies endorsing the safety of hormone replacement therapy in endometrial cancer patients argue against the detrimental effect of estrogen in endometrial cancer patients and, therefore, in CAH/ EIN as well. Our study demonstrates a low incidence of ovarian malignancy in women with CAH/EIN, especially in women b65 years of age, providing compelling evidence to support ovarian preservation. As data increase regarding the health benefits of ovarian preservation in postmenopausal women, a paradigm shift in the surgical management of CAH in these same women should follow. doi:10.1016/j.ygyno.2015.01.202
201 — Poster Session Relationship of locus of control and depression to treatment adherence in gynecologic oncology patients R. Viswanathana, R. Ranaa, Y.C. Leeb, I. Alagkiozidisb, M. Reinhardta, A. Araina, J. Tolentinob, T.S. Pradhanc. aSUNY Downstate Medical Center, Brooklyn, NY, USA, bSUNY Downstate, Brooklyn, NY, USA, cNew York Medical College, Valhalla, NY, USA Objectives: To explore the prevalence of depression before commencing treatment and determine if treatment adherence can be predicted by initial depression and Health Locus of Control in a prospective cohort of adult patients newly diagnosed with gynecologic cancer. Methods: A total 57 patients were administered the Patient Health Questionnaire (PHQ)-9 for depression and the Multidimensional Health Locus of Control (MHLC) questionnaire before start of cancer treatment. At the completion of treatment, adherence to chemotherapy, radiation treatment, and laboratory and clinic visits was calculated as the proportions of total prescribed visits that were kept. A 2-tailed significance level of 0.05 was used for correlation coefficients and ANOVA. Results: Overall adherence rates were as follows (mean + SD): Chemotherapy 0.88 + 0.26 (n = 56); radiation treatment 0.72 + 0.39 (n = 29); clinic visits 0.94 + 0.19; and laboratory visits 0.92 + 0.23. The PHQ-9 score mean was 3.25 + 3.9; only five patients (9%) had a score of 10 or above, indicating warranting clinical attention. Internal locus of control was positively related to chemotherapy adherence both by correlation (r 0.28, P = 0.04) and ANOVA, dividing groups into low internals (scoring at the median of 28 or below, n = 31, mean adherence 0.81 + 0.32, 95% CI 0.69–0.93) and high internals (scoring above median, n = 25, mean adherence 0.97 + 0.08, 95% CI 0.94–1), (F 5.6, df 1.54, P = 0.02). The two other MHLC domains and depression were not related to any of the adherence measures by correlation or ANOVA. Chemotherapy adherence was positively correlated to clinic visit adherence (r 0.53, P b 0.001) and laboratory visit adherence (r 0.59, P b 0.001). Radiation treatment adherence was positively correlated to clinic visit adherence (r 0.58, P = 0.001) but not to laboratory visit adherence.
83
Conclusions: 1) Depression is low prior to initiation of cancer treatment; 2) internal locus of control is positively related to chemotherapy adherence; 3) depression and the “External” and “Powerful Others” domains of health locus of control are not related to treatment adherence; 4) clinic visit adherence is positively related to chemotherapy and radiation treatment adherence. Assessment of internal locus of control at the initiation of treatment may identify a subgroup of patients who may need more help with adherence. Promoting clinic visits may improve treatment adherence. doi:10.1016/j.ygyno.2015.01.203
202 — Poster Session Limited training exposure in intraoperative radiation therapy (IORT) may result in omission of its use in treating locally advanced gynecologic malignancies K.S. Grzankowski, J.B. Szender, S.B. Lele, K.O. Odunsi, P.J. Frederick. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: To evaluate the level of knowledge about intraoperative radiation therapy (IORT) among trainees and attending physicians and to characterize utilization of IORT in locally advanced primary or recurrent pelvic malignancies. Methods: An anonymous, cross-sectional survey was sent to obstetrics and gynecology residents, radiation oncology residents, gynecologic oncology fellows in training, and attending physicians in both gynecologic and radiation oncology. The survey included demographic questions, practice characteristics, and accessibility or utilization of IORT. Survey participants were additionally asked to elucidate the modes and intensity of exposure to IORT training during residency and fellowship, and their knowledge was assessed through a short true–false quiz. Results: Out of 1250 physicians surveyed, 403 responded (32%). Most respondents were gynecologic oncologists (68%), female (55%), attending physicians (58%), and worked in a city/urban university setting (75%). More than 70% of respondents reported no exposure to IORT during residency/fellowship training and only 17% reported using IORT in the past year (most commonly for cervical or uterine cancers). Twenty-eight percent of respondents had IORT available in their practice, 44% did not, and 28% were unaware of its availability. Leading reasons for not using IORT were: 1) lack of appropriate equipment, 2) absence of radiation oncology support, and 3) unfamiliarity with IORT. Only 60% of respondents correctly answered the true–false quiz questions. Only 6% to 7% of faculty reported training residents and fellows in IORT. Conclusions: Lack of IORT in residency and fellowship training is a potentially modifiable reason for decreased utilization of this unique treatment modality that is effective in gynecologic malignancies. Organized didactic and hands-on instruction could improve familiarity and possibly utilization. doi:10.1016/j.ygyno.2015.01.204
203 — Poster Session Predictors of 30-day readmission in gynecologic oncology S. Uppala, M. Stasenkoa, K. McLeana, J.R. Liub, C.M. Johnstonb, R.K. Reynoldsb. aUniversity of Michigan Health Systems, Ann Arbor, MI, USA, b University of Michigan, Ann Arbor, MI, USA Objectives: The goals of this study were to identify predictors of 30day readmission for patients undergoing surgery for gynecologic malignancies and to identify patients at a high risk of readmission. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) for the years 2011 and 2012 with
Abstracts / Gynecologic Oncology 137 (2015) 2–91
Results: Study entry was offered to 22 women, with 19 consenting participants. Mean age was 52 years and 79% were Caucasian. The presentation significantly improved satisfaction with the care provider, with a mean change of 1.4 (standard deviation [SD] 2.1), P = 0.005. Ten of 19 women (53%) indicated maximal satisfaction on both instruments before and after viewing the presentation, with an insignificant mean change in CSQ-8 score 0.3 (SD 1.4), P = 0.13. Mean baseline FACT-G7 was 17.6 (SD 5.5), and this score was not correlated with any of the pre or postpresentation satisfaction measures. Need for timely completion of the nurse education and laboratory portions of the preoperative visit limited the ability to consistently offer study entry. Conclusions: Baseline satisfaction with informed consent before surgery is high. The use of supplemental multimedia is feasible but may be of more benefit at points of care beyond the preoperative encounter. doi:10.1016/j.ygyno.2015.01.199
198 — Poster Session A comparison of epidural analgesia and patient controlled intravenous analgesia on postoperative pain control and recovery parameters in women undergoing laparotomy for gynecologic malignancy K. Tucker, C. Murray-Krezan, C. Muller, T. Rutledge. University of New Mexico, Albuquerque, Albuquerque, NM, USA Objectives: Postoperative pain is a common fear of patients before surgery and adequate pain control is frequently used as a quality measure in surgical care delivery. The question of whether epidural analgesia (EA) provides better pain control than patient-controlled parenteral opioid analgesia (PCA) remains controversial. We sought to determine the effect of EA compared to PCA on postoperative recovery parameters and pain scores. Methods: A retrospective analysis of patients with gynecologic malignancy who had a laparotomy at the University of New Mexico from 2011 to 2013 was performed. Clinical and demographic variables were collected. Descriptive statistics were used to summarize patient characteristics. Linear mixed modeling was used to calculate the least squares mean postoperative pain scores after adjusting for PCA/EA use, demographic characteristics, and repeated measures. Results: A total of 159 patients met study criteria: 80 received EA and 79 received PCA. Hispanics and Native Americans represented 51% of the patients. Ovarian cancer was the most common cancer type (48%). Demographic, preoperative, and intraoperative factors were similar between groups. Patients in the EA group had both a significantly longer length of stay and longer time to Foley catheter removal, first ambulation, and flatus (all P ≤ 0.01). The median length of stay was 5 vs. 3 days in the EA vs. PCA group (P b 0.01). The number of patients with postoperative complications was significantly higher in the EA group (P b 0.01). The EA group reported lower pain scores compared to the PCA group over postoperative days 0, 1, and 2 (P = 0.04). After controlling for postoperative day, the mean pain score (using the Numeric Rating Scale) for the PCA group was 3.4 (95% CI: 3.0–3.8) compared to 2.8 in the EA group (95% CI: 2.5–3.2). Neither ethnicity nor language preference influenced analgesia choice or postoperative pain scores. Conclusions: In this ethnically diverse population, EA provided superior pain control after laparotomy for gynecologic malignancy. However, EA was associated with a longer length of stay, a delayed achievement of postoperative milestones, and a higher prevalence of postoperative complications. The optimal postoperative pain control method that achieves a balance of all pertinent postoperative outcomes remains elusive. doi:10.1016/j.ygyno.2015.01.200
199 — Poster Session Are hospital readmissions an accurate measure of quality cancer care in gynecologic oncology patients? D.N. Pasko, J.D. Boone, E.D. Thomas, W.K. Huh, R.D. Alvarez, C.A. Leath III, J.M. Straughn Jr. University of Alabama at Birmingham, Birmingham, AL, USA Objectives: Readmissions are routinely reported by the University HealthSystem Consortium (UHC) to measure quality care at academic health centers. The objective of this study was to evaluate gynecologic oncology (GO) readmission rates and associated factors to identify potentially preventable readmissions. Methods: A retrospective review of the UHC database for GO readmissions at our institution from January 2011 to July 2014 was performed. Abstracted data included patient and disease characteristics and readmissions defined by UHC criteria. Planned admissions for chemotherapy and radiation therapy were excluded. After independent physician review, reasons for readmissions considered potentially preventable included nausea/vomiting, abdominal pain, and failure to thrive. Outcome measures were 30-day readmission rates and readmission diagnoses. Results: A total of 3781 GO patients were hospitalized. There were 189 readmissions among 159 patients. The mean age was 55 years and mean body mass index was 28.9; 65.6% of the patients were white. Medicare and Medicaid insured 61.4% of patients. A total of 127 patients had a malignant primary diagnosis; the most common were ovarian cancer (52.8%), cervical cancer (22.8%), and uterine cancer (18.1%). Within 21 days of initial admission, chemotherapy was given to 43.2% of patients with ovarian cancer, and 37.9% of patients with cervical cancer had undergone surgery, chemotherapy, and/or radiation therapy 21 days prior to initial admission. Twentysix patients had benign disease and three patients had premalignant disease. The most common 30-day readmission diagnoses were wound complications (23.3%), intestinal obstruction (15.9%), pelvic abscess (9.0%), renal abnormalities (7.9%), nausea and vomiting (6.3%), pulmonary disorders (6.3%), abdominal pain (5.3%), and failure to thrive (5.3%). Thirty-eight of 189 (20.1%) readmissions were considered potentially preventable. Conclusions: A minority of patients readmitted to our GO service had potentially preventable conditions. Most factors associated with readmission cannot be modified, which may indicate that readmission rates are not an appropriate measure of quality care. Based on these data, future quality improvement efforts should be directed toward GO patients who have received therapy before admission and have potentially preventable conditions. doi:10.1016/j.ygyno.2015.01.201
200 — Poster Session Beyond fertility: The safety of ovarian preservation in women with complex endometrial hyperplasia with atypia K.M. Anderson, N.R. Shah, M.A. Davis, L.M. Bean, C.C. Saenz, S.C. Plaxe, M.T. McHale. UCSD Rebecca and John Moores Cancer Center, La Jolla, CA, USA Objectives: To evaluate the safety of ovarian preservation in women undergoing surgical management of complex endometrial hyperplasia with atypia (CAH) and endometrial intraepithelial neoplasms (EIN). Methods: The University HealthSystem Consortium database was queried from 10/2010 to 7/2014 to identify women with CAH and EIN managed with hysterectomy with or without adnexectomy. The risk of occult ovarian malignancy at the time of surgical management was calculated, then further stratified by age b65 or ≥65 years.
Abstracts / Gynecologic Oncology 137 (2015) 2–91
Results: Over a 4-year period, 2730 women were identified with CAH and EIN who underwent any type of hysterectomy. Of these patients, 2315 had concurrent bilateral or unilateral oophorectomy (83.2%). Occult ovarian cancer was found in 27 of these cases, representing an overall risk of 1.2%. Stratified by age, 15 of 1838 women b65 years of age and 12 of 477 who were ≥65 years old had ovarian cancer on final pathology, representing an 0.8% and 2.5% risk of ovarian cancer in these age groups, respectively. We determined the relative risk of occult ovarian malignancy at the time of surgical management of CAH to be 3.1 at age ≥65 vs. age b65 years (relative risk 3.08, 95% CI 1.5–6.5, Fisher's exact test P b 0.006). Conclusions: Conventional management of CAH/EIN in women who have completed childbearing does not differ from that of endometrial cancer, including total abdominal hysterectomy/bilateral salpingooophorectomy. This practice is compelled by the theoretical risk of continued hormonal stimulation of residual endometrial disease, the risk of a synchronous ovarian malignancy, and the risk of metastasis to the ovary. Studies endorsing the safety of hormone replacement therapy in endometrial cancer patients argue against the detrimental effect of estrogen in endometrial cancer patients and, therefore, in CAH/ EIN as well. Our study demonstrates a low incidence of ovarian malignancy in women with CAH/EIN, especially in women b65 years of age, providing compelling evidence to support ovarian preservation. As data increase regarding the health benefits of ovarian preservation in postmenopausal women, a paradigm shift in the surgical management of CAH in these same women should follow. doi:10.1016/j.ygyno.2015.01.202
201 — Poster Session Relationship of locus of control and depression to treatment adherence in gynecologic oncology patients R. Viswanathana, R. Ranaa, Y.C. Leeb, I. Alagkiozidisb, M. Reinhardta, A. Araina, J. Tolentinob, T.S. Pradhanc. aSUNY Downstate Medical Center, Brooklyn, NY, USA, bSUNY Downstate, Brooklyn, NY, USA, cNew York Medical College, Valhalla, NY, USA Objectives: To explore the prevalence of depression before commencing treatment and determine if treatment adherence can be predicted by initial depression and Health Locus of Control in a prospective cohort of adult patients newly diagnosed with gynecologic cancer. Methods: A total 57 patients were administered the Patient Health Questionnaire (PHQ)-9 for depression and the Multidimensional Health Locus of Control (MHLC) questionnaire before start of cancer treatment. At the completion of treatment, adherence to chemotherapy, radiation treatment, and laboratory and clinic visits was calculated as the proportions of total prescribed visits that were kept. A 2-tailed significance level of 0.05 was used for correlation coefficients and ANOVA. Results: Overall adherence rates were as follows (mean + SD): Chemotherapy 0.88 + 0.26 (n = 56); radiation treatment 0.72 + 0.39 (n = 29); clinic visits 0.94 + 0.19; and laboratory visits 0.92 + 0.23. The PHQ-9 score mean was 3.25 + 3.9; only five patients (9%) had a score of 10 or above, indicating warranting clinical attention. Internal locus of control was positively related to chemotherapy adherence both by correlation (r 0.28, P = 0.04) and ANOVA, dividing groups into low internals (scoring at the median of 28 or below, n = 31, mean adherence 0.81 + 0.32, 95% CI 0.69–0.93) and high internals (scoring above median, n = 25, mean adherence 0.97 + 0.08, 95% CI 0.94–1), (F 5.6, df 1.54, P = 0.02). The two other MHLC domains and depression were not related to any of the adherence measures by correlation or ANOVA. Chemotherapy adherence was positively correlated to clinic visit adherence (r 0.53, P b 0.001) and laboratory visit adherence (r 0.59, P b 0.001). Radiation treatment adherence was positively correlated to clinic visit adherence (r 0.58, P = 0.001) but not to laboratory visit adherence.
83
Conclusions: 1) Depression is low prior to initiation of cancer treatment; 2) internal locus of control is positively related to chemotherapy adherence; 3) depression and the “External” and “Powerful Others” domains of health locus of control are not related to treatment adherence; 4) clinic visit adherence is positively related to chemotherapy and radiation treatment adherence. Assessment of internal locus of control at the initiation of treatment may identify a subgroup of patients who may need more help with adherence. Promoting clinic visits may improve treatment adherence. doi:10.1016/j.ygyno.2015.01.203
202 — Poster Session Limited training exposure in intraoperative radiation therapy (IORT) may result in omission of its use in treating locally advanced gynecologic malignancies K.S. Grzankowski, J.B. Szender, S.B. Lele, K.O. Odunsi, P.J. Frederick. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: To evaluate the level of knowledge about intraoperative radiation therapy (IORT) among trainees and attending physicians and to characterize utilization of IORT in locally advanced primary or recurrent pelvic malignancies. Methods: An anonymous, cross-sectional survey was sent to obstetrics and gynecology residents, radiation oncology residents, gynecologic oncology fellows in training, and attending physicians in both gynecologic and radiation oncology. The survey included demographic questions, practice characteristics, and accessibility or utilization of IORT. Survey participants were additionally asked to elucidate the modes and intensity of exposure to IORT training during residency and fellowship, and their knowledge was assessed through a short true–false quiz. Results: Out of 1250 physicians surveyed, 403 responded (32%). Most respondents were gynecologic oncologists (68%), female (55%), attending physicians (58%), and worked in a city/urban university setting (75%). More than 70% of respondents reported no exposure to IORT during residency/fellowship training and only 17% reported using IORT in the past year (most commonly for cervical or uterine cancers). Twenty-eight percent of respondents had IORT available in their practice, 44% did not, and 28% were unaware of its availability. Leading reasons for not using IORT were: 1) lack of appropriate equipment, 2) absence of radiation oncology support, and 3) unfamiliarity with IORT. Only 60% of respondents correctly answered the true–false quiz questions. Only 6% to 7% of faculty reported training residents and fellows in IORT. Conclusions: Lack of IORT in residency and fellowship training is a potentially modifiable reason for decreased utilization of this unique treatment modality that is effective in gynecologic malignancies. Organized didactic and hands-on instruction could improve familiarity and possibly utilization. doi:10.1016/j.ygyno.2015.01.204
203 — Poster Session Predictors of 30-day readmission in gynecologic oncology S. Uppala, M. Stasenkoa, K. McLeana, J.R. Liub, C.M. Johnstonb, R.K. Reynoldsb. aUniversity of Michigan Health Systems, Ann Arbor, MI, USA, b University of Michigan, Ann Arbor, MI, USA Objectives: The goals of this study were to identify predictors of 30day readmission for patients undergoing surgery for gynecologic malignancies and to identify patients at a high risk of readmission. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) for the years 2011 and 2012 with