- Email: [email protected]
Ethnicity reporting practices of assisted reproduction clinics
P-457 Wednesday, October 27, 2010 PATIENT PAIN PERCEPTION WITH HYSTEROSALPINGOGRAM VERSUS HYSTEROSCOPY IN INFERTILITY EVALUATION. L. M. Brayboy, E. M. Murphy, J. D. Cohen, S. G. Somkuti, M. Sobel, L. I. Barmat. Department of Obstetrics and Gynecology, Abington Reproductive Medicine, Abington, PA. OBJECTIVE: Our aim is to assess pre and post procedure pain and to compare perceived pain between hysterosalpingogram (HSG) and hysteroscopy. DESIGN: This is a prospective study conducted in a community hospital with 48 women undergoing outpatient HSG and 248 women having outpatient 2.8mm hysteroscopy from 7/2009 to 3/2010. MATERIALS AND METHODS: Patients were directed to take NSAIDs prior to each procedure. No anesthesia was used. Consented patients undergoing an infertility evaluation were eligible. Incomplete questionnaires were excluded. Patients were questioned regarding their pain using a visual analog scale immediately pre and post operatively. Scores were incoporated in a database. SAS version 9.1 was used for statistical analysis using the Mantel-Haenszel test for crosstab analysis of categorical variables and when indicated the Fisher’s exact test. A two-sided p-value of <0.05 was considered statistically significant. RESULTS: The main outcome measures were patients’ preconceived pain perception before HSG and hysteroscopy compared to actual pain. Post procedure pain scores for the two tests were also examined. The hysteroscopy group had higher pre procedure pain expectations compared to the HSG group (36.1% vs18.9%, p¼ .018). Expected pain scores and actual post procedure scores were not significantly different (hysteroscopy 36.1% vs 44.2%, p¼0.26 & HSG 18.7% vs 26.0%, p¼0.19). Pain scores associated with the actual procedure showed severe pain in 44.2% of women undergoing hysteroscopy vs 26% undergoing HSG (p¼ .02) Immediately postop 85.7% of women in the hysteroscopy group were pain free vs. 46.1% in the HSG group (p¼< .0001). Five minutes after both procedures pain scores were equivalent (p¼ .13). CONCLUSION: These results show hysteroscopy has higher expected and actual pain perception compared to HSG. Interestingly, hysteroscopy patients recovered quicker than HSG patients. However, by 5 minutes this difference dissipated. Ongoing research will examine risk factors that are associated with higher pain scores.
P-458 Wednesday, October 27, 2010 FACTORS ASSOCIATED WITH THE TRANSITION TO SEEKING FERTILITY MEDICAL TREATMENT. FINDINGS FROM THE INTERNATIONAL FERTILITY DECISION-MAKING STUDY (IFDMS). L. E. Bunting, I. Tsibulsky, J. Boivin. School of Psychology, Cardiff University, Cardiff, United Kingdom; Merck Serono S.A., Geneva, Switzerland. OBJECTIVE: IFDMS investigated factors associated with engagement in the medical process. DESIGN: Cross-sectional study compared participants after one year of unsuccessful attempts to conceive: no medical (NONE n¼1165), medical advice (ADVICE n¼476), first line treatment (FIRST e.g., diagnostics n¼1946), OI injections (INJECT n¼830) or ART (n¼1242). MATERIALS AND METHODS: 45-minute English survey translated to 12 languages, implemented online in 18 countries (incl. US, Mexico). RESULTS: Average age was 31.8 5.9 yrs and time trying to conceive was 2.8 2.9 yrs with 6246 female and 1250 male respondents. Discriminant analysis identified four significant dimensions: ‘Norms & awareness’ (42.5% explained variance X2(144)¼3625.1,p< .001) had highest loading items of suspecting a fertility problem (.361), knowledge of free treatment (.546), ease discussing fertility with partner (.576) family (.386) & friends (.350); ‘Readiness & Willingness’ (6.3% variance X2(105)¼506.1,p< .001) had factors concerning reproductive life stage (i.e., age -.320, yrs married -.333, yrs infertile -.456), attitude-to-treatment variables (i.e., treatment success rate .511, desire to use medical treatment 350, positive beliefs about treatment .329, need for parenthood .309); ‘Context’ (1.3% variance X2(68)¼68,p< .001) was defined by physical health (SF-36) and relationship happiness; ‘Gender’ explained less than 1% of variability. ‘Norms & Awareness’ were more positive for INJECT and ART versus NONE and ADVICE groups. Readiness & Willingness’ were higher for ADVICE and FIRST vs. NONE and ART. More positive ‘Context’ discriminated ADVICE vs. NONE and ART vs. INJECT. Country comparisons with US will be presented.
FERTILITY & STERILITYÒ
CONCLUSION: People need to recognise their risk for a fertility problem and need positive support from their close network to initiate treatment. Support from social networks, knowledge of free treatment, relational and physical strength may be key in transitioning to ART. Supported by: Merck Serono S.A & the Economic & Social Research Council [RES-355-25-0038].
P-459 Wednesday, October 27, 2010 SEMEN DONORS WHO ARE OPEN TO CONTACT WITH THEIR OFFSPRING. W. Kramer, K. Daniels, M. Perez-y-Perez. Donor Sibling Registry, Nederland, CO; School of Social Work and Human Services, University of Canterbury, Christchurch, New Zealand. OBJECTIVE: The culture of gamete donation is undergoing a revolution. The previous practice of parents being secretive about their use of donated sperm, along with the accompanying anonymity of donors is changing. More offspring are now aware of being donor conceived. This has lead to increasing numbers of offspring wanting to know about their donors. What does this mean for donors, particularly those who were recruited on the basis of being anonymous? How do donors view/understand their relationships with their families and their donor offspring? Results relate to 164 former donors (76% from US) who now say they are willing to have contact with offspring they helped to create. DESIGN: Analyze surveys. MATERIALS AND METHODS: Online survey was completed by 164 donors. The 45 question survey included multiple choice and open-ended items and covered contact with offspring, motivations, the donor and his family, changing views over time, medical/ health issues, recruitment and patterns of donating. RESULTS: 77.5% donated to help families, 61% for the money and 41% to pass on their genes. 97.4% said they thought about the offspring they had helped to create and 93.8% said they were open to connecting with offspring. 22% had connected with offspring at the time of the survey. 71.4% of donors were currently married/partnered and of these 91% had told their partner and 85% of partners were open to connecting with the offspring. 57.7% of donors had children of their own and of these 38% know that their father has been a donor. 40% are too young to tell, and of these 85% will be told. Donors report that their feelings about donating have changed over time with the predominant theme being that they now realise donating semen was much more than a financial transaction. CONCLUSION: The changing culture of gamete donation is impacting all of the involved parties. Donors in this study are overwhelmingly open to contact/connecting with their offspring and this result challenges the traditional view that donors wish to remain anonymous.
PRACTICE MANAGEMENT P-460 Wednesday, October 27, 2010 ETHNICITY REPORTING PRACTICES OF ASSISTED REPRODUCTION CLINICS. T. L. B. Spitzer, A. Y. Armstrong, M. I. Cedars, V. Y. Fujimoto. Reproductive Sciences, University of California San Francisco, San Francisco, CA. OBJECTIVE: Multiple published reports have shown racial and ethnic disparities in ART outcomes. The magnitude of these effects in the US cannot be calculated, as patient ethnicity is reported to SART in less than 25% of IVF cycles (SART 2007 data). We sought to explore the current reporting practices of ART clinics. DESIGN: Nationwide cross-sectional survey of 384 SART clinics. MATERIALS AND METHODS: In April 2010, a brief 5-question online survey was distributed to 384 IVF clinic directors registered with SART regarding their reporting of ethnicity, as it relates to assisted reproduction. RESULTS: 85 SART clinics participated, with varying patient demographics, volume (20-3500 cases per year), and clinical setting (universitybased and private practices). Of participating clinics, 75% always report race/ethnicity data to SART. Of the remaining 25% who never or sometimes report, reasons for not reporting included lack of time, little ethnic heterogeneity, and feelings of clinical
S225
unimportance. Eighty-five percent of these clinics do not collect ethnicity information at all.
SART Ethnicity Reporting Survey
1. Approximately how many ART cycles does your clinic start each year? 2. Do you report the race/ethnicity of your patients to SART? 3. If not, why? 4. If you answered ‘‘Yes’’ or ‘‘Sometimes’’ to question #2, in what way(s) do you collect race/ethnicity data? 5. Do you use race/ethnicity literature data when counseling your infertility patients?
CONCLUSION: Based on this survey, reasons for not reporting ethnicity include lack of standardized data collection guidelines and little up-to-date literature. However, existing literature on ethnic disparities in ART is limited by poor reporting. Making ethnicity a required field in the SART database would help expand this literature and better inform clinicians and patients.
P-461 Wednesday, October 27, 2010 COMPARISON OF THE EFFECTIVENESS OF FALLOPIAN TUBE SPERM PERFUSION (FSP) WITH INTRAUTERINE INSEMINATION (IUI) IN THE TREATMENT OF NON-TUBAL INFERTILITY: A PROSPECTIVE RANDOMIZED STUDY. S. Furuya, T. Kagawa, K. Kubonoya. Obstetrics & Gynecology, Kubonoya Ob/Gyn Clinic, Kashiwa City, Chiba Prefecture, Japan. OBJECTIVE: Since Kahn et al. (1992) first described a method of Fallopian tube sperm perfusion (FSP), some promising results have been reported using FSP in comparison with intrauterine insemination (IUI). The aim of this study is to re-assess the relative efficacy of FSP versus IUI in the treatment of non-tubal infertile women who had failed to conceive by several IUI cycles. DESIGN: A prospective randomized study. MATERIALS AND METHODS: 158 infertile women with non-tubal factor, who had not conceived by three times or more standard IUI cycles, were enrolled in this study. They were randomized for treatment with either FSP(Group A: using 4 ml of sperm suspension) or further continuing IUI(group B; using 0.5ml of serm suspension). They were treated up to three attempts by allocated method. The number of clinical pregnancies was compared between groups. When pregnancy had not occurred even after three cycles using allocated method, treatment cycles by an alternative non-allocated method were further attempted. RESULTS: No pregnancy occurred with subsequent IUI cycles in 16 cases of Group A, who had failed to conceive by FSP. Three pregnancies out of 20 cases of Group B, who had failed to conceive by IUI, were finally attained with subsequent FSP maneuver.
The distribution of pregnancy rates per cycle after three cycles by allocated treatment method (n¼158, 322 cycles) GROUP A (FSP n¼78) Treatment cycle 1 st 2nd 3rd Total
GROUP B (IUI n¼80)
No. of cycles
No. of pregnancies
Pregnancy rate (%)
No. of cycles
No. of pregnacies
Pregnancy rate(%)
78 56 32 166
9 6 2 17
11.5 10.7 6.3 10.2*
80 51 25 156
6 3 0 9
7.5 5.9 0 5.8*
* : N.S. CONCLUSION: 1) FSP itself could not offer statistically significant advantage over standard IUI in the treatment of non-tubal infertility of our study population. 2) Since some cases who could conceive only by FSP certainly exist, we might consider to apply more FSP technique to practical use before proceeding to ART.
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Abstracts
P-462 Wednesday, October 27, 2010 A COMPARISON OF ABDOMINAL, VAGINAL, LAPAROSCOPIC, AND ROBOTIC HYSTERECTOMIES: SURGICAL OUTCOMES AND OPERATIVE COST IN A SINGLE INSTITUTION. K. N. Wright, G. M. Jonsdottir, S. Jorgensen, J. I. Einarsson. Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA; Harvard School of Public Health, Boston, MA. OBJECTIVE: To determine the incidence and risk of operative complications, operative time, length of hospital stay, operative cost, and overall cost of different methods of hysterectomy including abdominal, vaginal, laparoscopic and robotic techniques. DESIGN: Retrospective analysis of 1075 consecutive cases of all patients who underwent a hysterectomy by any method in the year 2009. MATERIALS AND METHODS: Hospital billing data was used to identify patients and obtain charges. Electronic medical records were used to obtain patient characteristics. Categorical analysis was used to compare differences in the complications, operative time, length of stay, operative cost, and overall cost between methods of hysterectomy. RESULTS: 1075 women were identified (ages 18-91). 385 (35.8%) were abdominal, 147 (13.7%) were vaginal, 480 (44.7%) were laparoscopic, and 63 (5.9%) were robotic. The following differences were found between abdominal, vaginal, laparoscopic, and robotic hysterectomies, respectively. Rate of intraoperative complication was 7.8%, 2.7%, 2.1%, and 1.6% (p < 0.001). The mean operative time was 196, 164, 188, and 267 minutes (p < 0.001). The mean length of inpatient stay was 3.35, 1.24, 1.03, and 1.35 days (p < 0.001). The mean operative cost was $33,458, $28,310, $34,047, and $46,183 (p < 0.001). The mean overall cost was $48,720, $41,143, $41,436, and $50,758 (p < 0.001). Multivariate linear regression analysis confirmed the independent effect of method of hysterectomy on length of stay (p < 0.001), complication rate (p ¼ 0.003), operative cost (p ¼ 0.004), and overall cost of stay (p ¼ 0.014). BMI was found to be the most important predictor of operative time and operative cost (p < 0.001) regardless of method of hysterectomy. CONCLUSION: Method of hysterectomy is an important factor on the length of stay, complication rate, operative cost, and overall cost of stay. Operative time and operative cost were most strongly associated with BMI rather than method of hysterectomy.
P-463 Wednesday, October 27, 2010 A RETROSPECTIVE ANALYSIS OF THE EFFECTS OF L-METHYLFOLATE AND ACTIVE VITAMIN B12 ON HEMOGLOBIN LEVELS THROUGHOUT PREGNANCY. S. W. Bentley, A. Hermes, D. Phillips. Women’s Clinic Shoals, Sheffield, AL; Gainesville Obstetrics & Gynecology, Gainesville, TX; Women’s Health Associates, Flowood, MS. OBJECTIVE: The purpose of this study was to evaluate the effect of active folate and B12 on hemoglobin (Hgb) levels throughout full-term pregnancy. DESIGN: This study was a retrospective, multi-site, two-arm chart review of pregnant females, age 21-39, who had taken either Neevo/NeevoDHA or a standard prenatal vitamin(PNV) from at least week 12 of pregnancy to delivery. For inclusion in the standard PNV arm, patients must have taken a PNV that contained %1mg folic acid, 27-35mg iron, and %12mcg of vitamin B12. Inclusion: Patients with a successful delivery between 1/1/09 and 12/31/09-charts were screened for the most recent devliery on or before 12/31/09 and continuing by delivery date in reverse chronological order until the sample size was met. MATERIALS AND METHODS: Data was de-identified and coded when collected. Three sites recorded the following data: Hgb at initiation of prenatal care (weeks 1-12);(weeks 22-28); and at the time of delivery.Patient demographics and BMI were also recorded. Fisher Exact test; chi square analysis-used for categorical variables such as race; Student-t test; analysis of variance-used for conditions variable such as age and Hgb values. RESULTS: Data from 112 (58 active, 54 control) charts were analyzed. There were no significant differences between the two groups in age, race, or BMI. At the initiation of prenatal care, there was no difference between the NeevoÒ and the NeevoDHAÒ group’s mean Hgb value (12.4 1.2) and that of the standard PNV group (12.1 1.2)(p¼0.124). At the end of second trimester, mean Hgb in the NeevoÒ and the NeevoDHAÒ group was 11.8 compared to the 11.3 in the standard PNV group (p¼0.011). At the time of delivery, mean Hgb was 11.8 in the NeevoÒ and the NeevoDHAÒ group compared to the 10.7 in the standard PNV group (p¼0.001).
Vol. 94., No. 4, Supplement, September 2010
P-458 Wednesday, October 27, 2010 FACTORS ASSOCIATED WITH THE TRANSITION TO SEEKING FERTILITY MEDICAL TREATMENT. FINDINGS FROM THE INTERNATIONAL FERTILITY DECISION-MAKING STUDY (IFDMS). L. E. Bunting, I. Tsibulsky, J. Boivin. School of Psychology, Cardiff University, Cardiff, United Kingdom; Merck Serono S.A., Geneva, Switzerland. OBJECTIVE: IFDMS investigated factors associated with engagement in the medical process. DESIGN: Cross-sectional study compared participants after one year of unsuccessful attempts to conceive: no medical (NONE n¼1165), medical advice (ADVICE n¼476), first line treatment (FIRST e.g., diagnostics n¼1946), OI injections (INJECT n¼830) or ART (n¼1242). MATERIALS AND METHODS: 45-minute English survey translated to 12 languages, implemented online in 18 countries (incl. US, Mexico). RESULTS: Average age was 31.8 5.9 yrs and time trying to conceive was 2.8 2.9 yrs with 6246 female and 1250 male respondents. Discriminant analysis identified four significant dimensions: ‘Norms & awareness’ (42.5% explained variance X2(144)¼3625.1,p< .001) had highest loading items of suspecting a fertility problem (.361), knowledge of free treatment (.546), ease discussing fertility with partner (.576) family (.386) & friends (.350); ‘Readiness & Willingness’ (6.3% variance X2(105)¼506.1,p< .001) had factors concerning reproductive life stage (i.e., age -.320, yrs married -.333, yrs infertile -.456), attitude-to-treatment variables (i.e., treatment success rate .511, desire to use medical treatment 350, positive beliefs about treatment .329, need for parenthood .309); ‘Context’ (1.3% variance X2(68)¼68,p< .001) was defined by physical health (SF-36) and relationship happiness; ‘Gender’ explained less than 1% of variability. ‘Norms & Awareness’ were more positive for INJECT and ART versus NONE and ADVICE groups. Readiness & Willingness’ were higher for ADVICE and FIRST vs. NONE and ART. More positive ‘Context’ discriminated ADVICE vs. NONE and ART vs. INJECT. Country comparisons with US will be presented.
FERTILITY & STERILITYÒ
CONCLUSION: People need to recognise their risk for a fertility problem and need positive support from their close network to initiate treatment. Support from social networks, knowledge of free treatment, relational and physical strength may be key in transitioning to ART. Supported by: Merck Serono S.A & the Economic & Social Research Council [RES-355-25-0038].
P-459 Wednesday, October 27, 2010 SEMEN DONORS WHO ARE OPEN TO CONTACT WITH THEIR OFFSPRING. W. Kramer, K. Daniels, M. Perez-y-Perez. Donor Sibling Registry, Nederland, CO; School of Social Work and Human Services, University of Canterbury, Christchurch, New Zealand. OBJECTIVE: The culture of gamete donation is undergoing a revolution. The previous practice of parents being secretive about their use of donated sperm, along with the accompanying anonymity of donors is changing. More offspring are now aware of being donor conceived. This has lead to increasing numbers of offspring wanting to know about their donors. What does this mean for donors, particularly those who were recruited on the basis of being anonymous? How do donors view/understand their relationships with their families and their donor offspring? Results relate to 164 former donors (76% from US) who now say they are willing to have contact with offspring they helped to create. DESIGN: Analyze surveys. MATERIALS AND METHODS: Online survey was completed by 164 donors. The 45 question survey included multiple choice and open-ended items and covered contact with offspring, motivations, the donor and his family, changing views over time, medical/ health issues, recruitment and patterns of donating. RESULTS: 77.5% donated to help families, 61% for the money and 41% to pass on their genes. 97.4% said they thought about the offspring they had helped to create and 93.8% said they were open to connecting with offspring. 22% had connected with offspring at the time of the survey. 71.4% of donors were currently married/partnered and of these 91% had told their partner and 85% of partners were open to connecting with the offspring. 57.7% of donors had children of their own and of these 38% know that their father has been a donor. 40% are too young to tell, and of these 85% will be told. Donors report that their feelings about donating have changed over time with the predominant theme being that they now realise donating semen was much more than a financial transaction. CONCLUSION: The changing culture of gamete donation is impacting all of the involved parties. Donors in this study are overwhelmingly open to contact/connecting with their offspring and this result challenges the traditional view that donors wish to remain anonymous.
PRACTICE MANAGEMENT P-460 Wednesday, October 27, 2010 ETHNICITY REPORTING PRACTICES OF ASSISTED REPRODUCTION CLINICS. T. L. B. Spitzer, A. Y. Armstrong, M. I. Cedars, V. Y. Fujimoto. Reproductive Sciences, University of California San Francisco, San Francisco, CA. OBJECTIVE: Multiple published reports have shown racial and ethnic disparities in ART outcomes. The magnitude of these effects in the US cannot be calculated, as patient ethnicity is reported to SART in less than 25% of IVF cycles (SART 2007 data). We sought to explore the current reporting practices of ART clinics. DESIGN: Nationwide cross-sectional survey of 384 SART clinics. MATERIALS AND METHODS: In April 2010, a brief 5-question online survey was distributed to 384 IVF clinic directors registered with SART regarding their reporting of ethnicity, as it relates to assisted reproduction. RESULTS: 85 SART clinics participated, with varying patient demographics, volume (20-3500 cases per year), and clinical setting (universitybased and private practices). Of participating clinics, 75% always report race/ethnicity data to SART. Of the remaining 25% who never or sometimes report, reasons for not reporting included lack of time, little ethnic heterogeneity, and feelings of clinical
S225
unimportance. Eighty-five percent of these clinics do not collect ethnicity information at all.
SART Ethnicity Reporting Survey
1. Approximately how many ART cycles does your clinic start each year? 2. Do you report the race/ethnicity of your patients to SART? 3. If not, why? 4. If you answered ‘‘Yes’’ or ‘‘Sometimes’’ to question #2, in what way(s) do you collect race/ethnicity data? 5. Do you use race/ethnicity literature data when counseling your infertility patients?
CONCLUSION: Based on this survey, reasons for not reporting ethnicity include lack of standardized data collection guidelines and little up-to-date literature. However, existing literature on ethnic disparities in ART is limited by poor reporting. Making ethnicity a required field in the SART database would help expand this literature and better inform clinicians and patients.
P-461 Wednesday, October 27, 2010 COMPARISON OF THE EFFECTIVENESS OF FALLOPIAN TUBE SPERM PERFUSION (FSP) WITH INTRAUTERINE INSEMINATION (IUI) IN THE TREATMENT OF NON-TUBAL INFERTILITY: A PROSPECTIVE RANDOMIZED STUDY. S. Furuya, T. Kagawa, K. Kubonoya. Obstetrics & Gynecology, Kubonoya Ob/Gyn Clinic, Kashiwa City, Chiba Prefecture, Japan. OBJECTIVE: Since Kahn et al. (1992) first described a method of Fallopian tube sperm perfusion (FSP), some promising results have been reported using FSP in comparison with intrauterine insemination (IUI). The aim of this study is to re-assess the relative efficacy of FSP versus IUI in the treatment of non-tubal infertile women who had failed to conceive by several IUI cycles. DESIGN: A prospective randomized study. MATERIALS AND METHODS: 158 infertile women with non-tubal factor, who had not conceived by three times or more standard IUI cycles, were enrolled in this study. They were randomized for treatment with either FSP(Group A: using 4 ml of sperm suspension) or further continuing IUI(group B; using 0.5ml of serm suspension). They were treated up to three attempts by allocated method. The number of clinical pregnancies was compared between groups. When pregnancy had not occurred even after three cycles using allocated method, treatment cycles by an alternative non-allocated method were further attempted. RESULTS: No pregnancy occurred with subsequent IUI cycles in 16 cases of Group A, who had failed to conceive by FSP. Three pregnancies out of 20 cases of Group B, who had failed to conceive by IUI, were finally attained with subsequent FSP maneuver.
The distribution of pregnancy rates per cycle after three cycles by allocated treatment method (n¼158, 322 cycles) GROUP A (FSP n¼78) Treatment cycle 1 st 2nd 3rd Total
GROUP B (IUI n¼80)
No. of cycles
No. of pregnancies
Pregnancy rate (%)
No. of cycles
No. of pregnacies
Pregnancy rate(%)
78 56 32 166
9 6 2 17
11.5 10.7 6.3 10.2*
80 51 25 156
6 3 0 9
7.5 5.9 0 5.8*
* : N.S. CONCLUSION: 1) FSP itself could not offer statistically significant advantage over standard IUI in the treatment of non-tubal infertility of our study population. 2) Since some cases who could conceive only by FSP certainly exist, we might consider to apply more FSP technique to practical use before proceeding to ART.
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Abstracts
P-462 Wednesday, October 27, 2010 A COMPARISON OF ABDOMINAL, VAGINAL, LAPAROSCOPIC, AND ROBOTIC HYSTERECTOMIES: SURGICAL OUTCOMES AND OPERATIVE COST IN A SINGLE INSTITUTION. K. N. Wright, G. M. Jonsdottir, S. Jorgensen, J. I. Einarsson. Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA; Harvard School of Public Health, Boston, MA. OBJECTIVE: To determine the incidence and risk of operative complications, operative time, length of hospital stay, operative cost, and overall cost of different methods of hysterectomy including abdominal, vaginal, laparoscopic and robotic techniques. DESIGN: Retrospective analysis of 1075 consecutive cases of all patients who underwent a hysterectomy by any method in the year 2009. MATERIALS AND METHODS: Hospital billing data was used to identify patients and obtain charges. Electronic medical records were used to obtain patient characteristics. Categorical analysis was used to compare differences in the complications, operative time, length of stay, operative cost, and overall cost between methods of hysterectomy. RESULTS: 1075 women were identified (ages 18-91). 385 (35.8%) were abdominal, 147 (13.7%) were vaginal, 480 (44.7%) were laparoscopic, and 63 (5.9%) were robotic. The following differences were found between abdominal, vaginal, laparoscopic, and robotic hysterectomies, respectively. Rate of intraoperative complication was 7.8%, 2.7%, 2.1%, and 1.6% (p < 0.001). The mean operative time was 196, 164, 188, and 267 minutes (p < 0.001). The mean length of inpatient stay was 3.35, 1.24, 1.03, and 1.35 days (p < 0.001). The mean operative cost was $33,458, $28,310, $34,047, and $46,183 (p < 0.001). The mean overall cost was $48,720, $41,143, $41,436, and $50,758 (p < 0.001). Multivariate linear regression analysis confirmed the independent effect of method of hysterectomy on length of stay (p < 0.001), complication rate (p ¼ 0.003), operative cost (p ¼ 0.004), and overall cost of stay (p ¼ 0.014). BMI was found to be the most important predictor of operative time and operative cost (p < 0.001) regardless of method of hysterectomy. CONCLUSION: Method of hysterectomy is an important factor on the length of stay, complication rate, operative cost, and overall cost of stay. Operative time and operative cost were most strongly associated with BMI rather than method of hysterectomy.
P-463 Wednesday, October 27, 2010 A RETROSPECTIVE ANALYSIS OF THE EFFECTS OF L-METHYLFOLATE AND ACTIVE VITAMIN B12 ON HEMOGLOBIN LEVELS THROUGHOUT PREGNANCY. S. W. Bentley, A. Hermes, D. Phillips. Women’s Clinic Shoals, Sheffield, AL; Gainesville Obstetrics & Gynecology, Gainesville, TX; Women’s Health Associates, Flowood, MS. OBJECTIVE: The purpose of this study was to evaluate the effect of active folate and B12 on hemoglobin (Hgb) levels throughout full-term pregnancy. DESIGN: This study was a retrospective, multi-site, two-arm chart review of pregnant females, age 21-39, who had taken either Neevo/NeevoDHA or a standard prenatal vitamin(PNV) from at least week 12 of pregnancy to delivery. For inclusion in the standard PNV arm, patients must have taken a PNV that contained %1mg folic acid, 27-35mg iron, and %12mcg of vitamin B12. Inclusion: Patients with a successful delivery between 1/1/09 and 12/31/09-charts were screened for the most recent devliery on or before 12/31/09 and continuing by delivery date in reverse chronological order until the sample size was met. MATERIALS AND METHODS: Data was de-identified and coded when collected. Three sites recorded the following data: Hgb at initiation of prenatal care (weeks 1-12);(weeks 22-28); and at the time of delivery.Patient demographics and BMI were also recorded. Fisher Exact test; chi square analysis-used for categorical variables such as race; Student-t test; analysis of variance-used for conditions variable such as age and Hgb values. RESULTS: Data from 112 (58 active, 54 control) charts were analyzed. There were no significant differences between the two groups in age, race, or BMI. At the initiation of prenatal care, there was no difference between the NeevoÒ and the NeevoDHAÒ group’s mean Hgb value (12.4 1.2) and that of the standard PNV group (12.1 1.2)(p¼0.124). At the end of second trimester, mean Hgb in the NeevoÒ and the NeevoDHAÒ group was 11.8 compared to the 11.3 in the standard PNV group (p¼0.011). At the time of delivery, mean Hgb was 11.8 in the NeevoÒ and the NeevoDHAÒ group compared to the 10.7 in the standard PNV group (p¼0.001).
Vol. 94., No. 4, Supplement, September 2010