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Impact of a Minimally Invasive Gynecologic Surgeon on Patient Length of Stay Following Laparoscopic Hysterectomy
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 578 Hypoxia-Induced Genotype Switch in Nicotinamide Adenine Dinucleotide Phosphate (NADPH) Oxidase Through the Up-Regulation of Cytidine Deaminase Regulates Postoperative Adhesion Development Diamond MP,1 Fletcher NM,2 Neubauer BR,2 Saed MG,2 H.M. Abu-Soud,2 Saed GM.2 1Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia; 2Obstetrics and Gynecology, Wayne State University, Detroit, Michigan Study Objective: To determine the presence of C242T SNP (rs4673) in adhesion tissues (ADF) and whether hypoxia induces this SNP in normal peritoneal fibroblasts (NPF). We will also evaluate expression of Cytidine Deaminase, an enzyme responsible for converting cytosine bases to uracil, in NPF and ADF cells under normal and hypoxic conditions. Design: Retrospective cohort study. Setting: Medical Center. Patients: Peritoneal and adhesion human fibroblasts. Intervention: Hypoxia exposure. Measurements and Main Results: Fibroblasts isolated from ADF manifest a persistent pro-oxidant state as compared to normal peritoneal fibroblasts (NPF) isolated from the same patient(s). Hypoxia and resultant oxidative stress causes NPF to irreversibly acquire the adhesion phenotype. Moreover, ADF manifest an overexpression of NADPH oxidase associated with a tyrosine to histidine switch resulting from rs4673. Primary cultures of fibroblasts were previously established from normal peritoneal and adhesion tissues from the same patient. The NADPH oxidase SNP was analyzed using TaqMan probes that quantitate the abundance of this polymorphism in NPF and ADF before and after exposure to hypoxia (2% O2, 24 hrs.). Assessment of Cytidine Deaminase mRNA levels utilizing RT-PCR was performed. ADF exhibited increase in NADPH oxidase polymorphisms (53.7%, p\0.05) as compared to NPF (25.2%, p\0.05). Exposure of NPF to hypoxia significantly increased acquisition of this polymorphism, from 25.2 to 51.8% (p\0.05). Levels of Cytidine Deaminase were significantly increased in both NPF exposed to hypoxia (28%, p=0.0452) and in ADF (37%, p=0.0187). Conclusion: Hypoxia resulting from tissue injury triggers a genotype switch in NADPH oxidase, and possibly other key oxidants and antioxidants, leading to persistence of a pro-oxidant state, which contributes to the development of postoperative adhesions. The mechanism of this genotype switch involves Upregulation of Cytidine Deaminase. Scavenging oxidants as well as targeting cytidine deaminase may have beneficial preoperative effects. 579 Diagnostics and Treatment for Uterine Leiomyosarcomas in Norway in the Period 2000 to 2012 Skorstad M,1 Kent A,3 Lieng M.2 1Womens Clinic, Vestfold Hospital, Tonsberg, Norway; 2Womens Clinic, Oslo University Hospital, Oslo, Norway; 3Health Sciences, University of Surrey, Guildford, United Kingdom Study Objective: To assess the rate of preoperatively unidentified uterine leiomyosarcomas (LMS) and explore which diagnostic tools were used in each case in order to debate whether or not today’s examinations are sufficient enough to distinguish LMS from benign uterine myomas and allow minimal invasive surgery (MIS) procedures including tissue morcellation on presumed benign myomas. Design: Retrospective cohort study, nationwide cohort over a decade. Setting: Data from the Norwegian Cancer Registry. Patients: All women with diagnosed uterine LMS in Norway in the period 2000 to 2012. Intervention: Retrospectively collected information from nationwide registry data and from the patients’ journals. Measurements and Main Results: A total of 221 women have been diagnosed with LMS during the study period. The study is not finished; it is expected to be complete in September 2015. We will report the ratio of LMS diagnosed before treatment vs. after. Furthermore, preoperative
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diagnostic tools used will be investigated as well as factors such as age, BMI, menopausal status, hormone replacement treatment and smoking status. Conclusion: Ongoing analyses. We will determine the rate of undiagnosed LMS prior to surgery, the rate of morcellated LMS, the value of different diagnostic tools and look for specific risk factors/similarities amongst women with undiagnosed LMS. Based on the results, we will debate if the tissue morcellation restriction is exaggerated and the limitations of its use should be opened up for specific patient groups. 580 Impact of a Minimally Invasive Gynecologic Surgeon on Patient Length of Stay Following Laparoscopic Hysterectomy Clark NV,1 Moreno-Koehler AD,2 Price LL,2 Sebba AL,1 Harneet GS,1 Wright KN.1 1Department of Gynecology, Lahey Hospital and Medical Center, Burlington, Massachusetts; 2Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts Study Objective: To determine the impact of a minimally invasive gynecologic surgery (MIGS) provider on patient length of stay (LOS) following laparoscopic hysterectomy (LH) in a gynecology department. Design: Review of 552 patients who underwent an LH for benign or malignant indications from 2010 to 2014, encompassing a time period before and after the introduction of a fellowship-trained MIGS surgeon. Setting: A suburban, academic-affiliated tertiary care hospital. Patients: 552 women who underwent an LH by 13 members of a gynecology department. Intervention: Total or supracervical, and conventional or robotic-assisted LH. Measurements and Main Results: 222 women underwent LH before, and 330 women underwent LH after the introduction of a fellowship-trained MIGS specialist. LOS was reduced in the latter group with an odds ratio of 0.20 (p \ 0.001) for a LOS of 1 vs. 0 days, and 0.15 (p \ 0.001) for a LOS of R 2 vs. 0 days. While not statistically significant, when the MIGS specialist was excluded from the analysis, there was a reduction in LOS with an odds ratios of 0.86 (p = 0.48) for an LOS of 1 vs. 0 days, and 0.58 (p = 0.10) for an LOS of R 2 vs. 0 days. These findings were adjusted for robotic assistance, malignancy, and other factors suspected to affect LOS. Costs were reduced with a median total hospital cost of $7,568.00 vs. $8,940.00 (p \ 0.001). Postoperative complications were low for both groups, and readmissions and unscheduled follow up visits did not differ significantly. Conclusion: A MIGS provider is associated with a shorter LOS following LH for all patients operated on by a gynecology department. A MIGS provider may influence other members of a gynecology department to decrease patient LOS following LH. This is associated with lower costs, with no difference in patient complications. 581 The Effectiveness and the Effect of the Obstetrics and Gynecology Medical School Clerkship on Future Career Choice By Gender Miller EE, Smith KS. Obstetrics and Gynecology, Howard University Hospital, Washington, District of Columbia Study Objective: This study will evaluate the effect of the mandatory third year clerkship in Obstetrics and Gynecology on the future career choice of male and female medical students and compare them by gender. This study will also evaluate how effectively the clerkship exposes the 3rd year medical students to the field of Ob/Gyn, and how changes made in the clerkship impact the students experience. Design: Cross-sectional study. Setting: Howard University Hospital, a LCME accredited medical school in an urban setting. Patients: Male and female medical students completing a clerkship in obstetrics and gynecology during the third year of medical school.
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diagnostic tools used will be investigated as well as factors such as age, BMI, menopausal status, hormone replacement treatment and smoking status. Conclusion: Ongoing analyses. We will determine the rate of undiagnosed LMS prior to surgery, the rate of morcellated LMS, the value of different diagnostic tools and look for specific risk factors/similarities amongst women with undiagnosed LMS. Based on the results, we will debate if the tissue morcellation restriction is exaggerated and the limitations of its use should be opened up for specific patient groups. 580 Impact of a Minimally Invasive Gynecologic Surgeon on Patient Length of Stay Following Laparoscopic Hysterectomy Clark NV,1 Moreno-Koehler AD,2 Price LL,2 Sebba AL,1 Harneet GS,1 Wright KN.1 1Department of Gynecology, Lahey Hospital and Medical Center, Burlington, Massachusetts; 2Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts Study Objective: To determine the impact of a minimally invasive gynecologic surgery (MIGS) provider on patient length of stay (LOS) following laparoscopic hysterectomy (LH) in a gynecology department. Design: Review of 552 patients who underwent an LH for benign or malignant indications from 2010 to 2014, encompassing a time period before and after the introduction of a fellowship-trained MIGS surgeon. Setting: A suburban, academic-affiliated tertiary care hospital. Patients: 552 women who underwent an LH by 13 members of a gynecology department. Intervention: Total or supracervical, and conventional or robotic-assisted LH. Measurements and Main Results: 222 women underwent LH before, and 330 women underwent LH after the introduction of a fellowship-trained MIGS specialist. LOS was reduced in the latter group with an odds ratio of 0.20 (p \ 0.001) for a LOS of 1 vs. 0 days, and 0.15 (p \ 0.001) for a LOS of R 2 vs. 0 days. While not statistically significant, when the MIGS specialist was excluded from the analysis, there was a reduction in LOS with an odds ratios of 0.86 (p = 0.48) for an LOS of 1 vs. 0 days, and 0.58 (p = 0.10) for an LOS of R 2 vs. 0 days. These findings were adjusted for robotic assistance, malignancy, and other factors suspected to affect LOS. Costs were reduced with a median total hospital cost of $7,568.00 vs. $8,940.00 (p \ 0.001). Postoperative complications were low for both groups, and readmissions and unscheduled follow up visits did not differ significantly. Conclusion: A MIGS provider is associated with a shorter LOS following LH for all patients operated on by a gynecology department. A MIGS provider may influence other members of a gynecology department to decrease patient LOS following LH. This is associated with lower costs, with no difference in patient complications. 581 The Effectiveness and the Effect of the Obstetrics and Gynecology Medical School Clerkship on Future Career Choice By Gender Miller EE, Smith KS. Obstetrics and Gynecology, Howard University Hospital, Washington, District of Columbia Study Objective: This study will evaluate the effect of the mandatory third year clerkship in Obstetrics and Gynecology on the future career choice of male and female medical students and compare them by gender. This study will also evaluate how effectively the clerkship exposes the 3rd year medical students to the field of Ob/Gyn, and how changes made in the clerkship impact the students experience. Design: Cross-sectional study. Setting: Howard University Hospital, a LCME accredited medical school in an urban setting. Patients: Male and female medical students completing a clerkship in obstetrics and gynecology during the third year of medical school.