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Risk Factors Associated With Emergency Room Visits and Hospital Readmission Following Benign Hysterectomy
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
201 Laparoscopic Bowel Resection for Deep Infiltrating Endometriosis: The CARE Experience Hengrasmee P, Lam A. Centre for Advanced Reproductive Endosurgery, St. Leonard’s, New South Wales, Australia Study Objective: To evaluate clinical manifestations and surgical outcomes of laparoscopic bowel resection for DIE. Design: Retrospective chart review. Setting: Centre for Advanced Reproductive Endosurgery (CARE) Patients: Women who presented at CARE with symptoms suggestive of bowel endometriosis. Intervention: Retrospective chart review of women undergoing laparoscopic bowel resection for DIE during January 2010 and December 2014. Measurements and Main Results: Mean age was 35.5 years old and mean BMI was 23.1 kg/m2. Among 30 women, 70% were nulliparous, 43.3% had infertility problem, 16.7% had at least two unsuccessful IVF cycles, and 60% had previous history of operative laparoscopy for endometriosis. The most common presenting symptoms included dysmenorrhea (86.7%), dyschezia (80%), bowel motion fluctuation (76.7%), and dyspareunia (73.3%). With logistic regression, symptoms of dysmenorrhea (p = 0.004) and dyspareunia (p = 0.007) were strongly correlated with the clinical finding of rectovaginal nodule. Reports of DIE from imaging studies were significant predictors of rectal endometriosis. For surgical outcomes, segmental resection with re-anastomosis was carried out in 90% of patients, among which 73.3% were performed with ultra-low rectal resection. Median resected bowel length was 67.5 mm. Distribution of endometriosis was demonstrated in rectum 96.7%, sigmoid 23.3%, appendix 10%, cecum 6.7%, and ileum 6.7%. Extent of endometriosis invasion on the bowel wall included 76.7% muscularis, 20% submucosa, and 3.3% mucosa. Median blood loss was 672 ml and median operative time was 180 minutes. There was only one case of leakage and one case of bleeding from anastomosis sites. Postoperative bowel dysfunction, including constipation and diarrhea, was as high as 90% while voiding difficulty occurred in only 30%. At 6 week follow-up, 90% of patients showed improvement in pain symptoms and 80% had better bowel function. Conclusion: Laparoscopic bowel resection is an effective surgical procedure for DIE. However, it requires multidisciplinary approach. Long-term follow-up is mandatory for actual estimation of pregnancy and recurrence rates.
202 Risk Factors Associated With Emergency Room Visits and Hospital Readmission Following Benign Hysterectomy Mahnert N,1 Lim C,1 Mowers E,1 Bethany S,1 Neil K,2 Daniel M,1 As-Sanie S.1 1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; 2School of Public Health, University of Michigan, Ann Arbor, Michigan Study Objective: To identify risk factors associated with emergency room visits and hospital readmission following benign hysterectomy. Design: Prospective analysis using a Michigan surgical database from July 1st 2012 through July 2nd 2014. Setting: Cases were abstracted from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative (MSQC). MSQC is a statewide group of 52 hospitals that voluntarily report perioperative surgical outcomes. Specially trained, dedicated nurses abstracted patient characteristics and perioperative data. Women who presented to an emergency room (ER) or were admitted to a hospital within 30 days of hysterectomy were included in the analysis. Women with an obstetric or cancer indication for hysterectomy and those with malignancy diagnosed on final pathology were excluded. Patients: During the study period, 20,935 women underwent a benign hysterectomy. Measurements and Main Results: Among women who underwent a benign hysterectomy, 9.1% presented to an ER and 2.9% were
readmitted to a hospital. Although most women were White, nonHispanic and had private insurance, women who presented to the ER were younger (44 years11.1 versus 47.7 years11.0, p\.001), and less likely to be White (72.9% versus 76.6%, p=.003) and have private insurance (60.6% versus 73.4%, p\.001). When controlling for demographic characteristics and perioperative factors, women with higher postoperative pain scores had increased odds of presenting to the ER. Preoperative factors associated with readmission included a low albumin level (55% versus 36.6%, p\.001), elevated white count (23.4%versus15.7%, p\.001), elevated platelets (16.7% versus 10.5%, p\.001) and prior venous thromboembolism (6.4% versus 2.7%, p\.001). Additionally, bleeding barrier utilization resulted in a 1.4 increased odds of readmission. Conclusion: Women presenting to the ER are characteristically different from the entire cohort and may have poorer postoperative pain control, which highlights the importance of patient counseling regarding expectations and postoperative pain management. Caution is warranted when using an intra-operative bleeding barrier given the potential for increased risk of readmission.
203 Endoscopy Surgery for Ectopic Pregnancy Within Cesarean Scar Jiang S, Sheng X, Li Q. Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan City, Shandong Province, China Study Objective: Ectopic pregnancy in a previous cesarean section scar is rarely reported, and is very difficult to manage. We reviewed the literature about cesarean scar pregnancy treated by laparoscopy or hysteroscopy alone. The case characteristics and endoscopic surgery techniques were summarized. The criteria for endoscopic management were recommended. Design: We thoroughly retrieved literature in Pubmed and other databases: Spinger, ScienceDirect, Google Scholar and other databases. We also presented the operation techniques of our two cases managed by laparoscopy alone. Setting: Clinical literature review. Patients: Two females were suspected suffering from ectopic pregnancy in a previous caesarean section scar under the impression of Doppler ultrasound. Conservative regimen was first applied to one patient but failed to demonstrate enough efficacy. The b-HCG of the other patient was extremely high so conservative treatment was not considered. Then laparoscopic surgery was performed for the two patients and not only confirmed the diagnosis but also removed the ectopic gestational products successfully. The operation under laparoscopy was very smoothly. Total operation time was 80 minutes, blood loss was only about 100ml and blood transfusion was not necessary.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
201 Laparoscopic Bowel Resection for Deep Infiltrating Endometriosis: The CARE Experience Hengrasmee P, Lam A. Centre for Advanced Reproductive Endosurgery, St. Leonard’s, New South Wales, Australia Study Objective: To evaluate clinical manifestations and surgical outcomes of laparoscopic bowel resection for DIE. Design: Retrospective chart review. Setting: Centre for Advanced Reproductive Endosurgery (CARE) Patients: Women who presented at CARE with symptoms suggestive of bowel endometriosis. Intervention: Retrospective chart review of women undergoing laparoscopic bowel resection for DIE during January 2010 and December 2014. Measurements and Main Results: Mean age was 35.5 years old and mean BMI was 23.1 kg/m2. Among 30 women, 70% were nulliparous, 43.3% had infertility problem, 16.7% had at least two unsuccessful IVF cycles, and 60% had previous history of operative laparoscopy for endometriosis. The most common presenting symptoms included dysmenorrhea (86.7%), dyschezia (80%), bowel motion fluctuation (76.7%), and dyspareunia (73.3%). With logistic regression, symptoms of dysmenorrhea (p = 0.004) and dyspareunia (p = 0.007) were strongly correlated with the clinical finding of rectovaginal nodule. Reports of DIE from imaging studies were significant predictors of rectal endometriosis. For surgical outcomes, segmental resection with re-anastomosis was carried out in 90% of patients, among which 73.3% were performed with ultra-low rectal resection. Median resected bowel length was 67.5 mm. Distribution of endometriosis was demonstrated in rectum 96.7%, sigmoid 23.3%, appendix 10%, cecum 6.7%, and ileum 6.7%. Extent of endometriosis invasion on the bowel wall included 76.7% muscularis, 20% submucosa, and 3.3% mucosa. Median blood loss was 672 ml and median operative time was 180 minutes. There was only one case of leakage and one case of bleeding from anastomosis sites. Postoperative bowel dysfunction, including constipation and diarrhea, was as high as 90% while voiding difficulty occurred in only 30%. At 6 week follow-up, 90% of patients showed improvement in pain symptoms and 80% had better bowel function. Conclusion: Laparoscopic bowel resection is an effective surgical procedure for DIE. However, it requires multidisciplinary approach. Long-term follow-up is mandatory for actual estimation of pregnancy and recurrence rates.
202 Risk Factors Associated With Emergency Room Visits and Hospital Readmission Following Benign Hysterectomy Mahnert N,1 Lim C,1 Mowers E,1 Bethany S,1 Neil K,2 Daniel M,1 As-Sanie S.1 1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; 2School of Public Health, University of Michigan, Ann Arbor, Michigan Study Objective: To identify risk factors associated with emergency room visits and hospital readmission following benign hysterectomy. Design: Prospective analysis using a Michigan surgical database from July 1st 2012 through July 2nd 2014. Setting: Cases were abstracted from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative (MSQC). MSQC is a statewide group of 52 hospitals that voluntarily report perioperative surgical outcomes. Specially trained, dedicated nurses abstracted patient characteristics and perioperative data. Women who presented to an emergency room (ER) or were admitted to a hospital within 30 days of hysterectomy were included in the analysis. Women with an obstetric or cancer indication for hysterectomy and those with malignancy diagnosed on final pathology were excluded. Patients: During the study period, 20,935 women underwent a benign hysterectomy. Measurements and Main Results: Among women who underwent a benign hysterectomy, 9.1% presented to an ER and 2.9% were
readmitted to a hospital. Although most women were White, nonHispanic and had private insurance, women who presented to the ER were younger (44 years11.1 versus 47.7 years11.0, p\.001), and less likely to be White (72.9% versus 76.6%, p=.003) and have private insurance (60.6% versus 73.4%, p\.001). When controlling for demographic characteristics and perioperative factors, women with higher postoperative pain scores had increased odds of presenting to the ER. Preoperative factors associated with readmission included a low albumin level (55% versus 36.6%, p\.001), elevated white count (23.4%versus15.7%, p\.001), elevated platelets (16.7% versus 10.5%, p\.001) and prior venous thromboembolism (6.4% versus 2.7%, p\.001). Additionally, bleeding barrier utilization resulted in a 1.4 increased odds of readmission. Conclusion: Women presenting to the ER are characteristically different from the entire cohort and may have poorer postoperative pain control, which highlights the importance of patient counseling regarding expectations and postoperative pain management. Caution is warranted when using an intra-operative bleeding barrier given the potential for increased risk of readmission.
203 Endoscopy Surgery for Ectopic Pregnancy Within Cesarean Scar Jiang S, Sheng X, Li Q. Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan City, Shandong Province, China Study Objective: Ectopic pregnancy in a previous cesarean section scar is rarely reported, and is very difficult to manage. We reviewed the literature about cesarean scar pregnancy treated by laparoscopy or hysteroscopy alone. The case characteristics and endoscopic surgery techniques were summarized. The criteria for endoscopic management were recommended. Design: We thoroughly retrieved literature in Pubmed and other databases: Spinger, ScienceDirect, Google Scholar and other databases. We also presented the operation techniques of our two cases managed by laparoscopy alone. Setting: Clinical literature review. Patients: Two females were suspected suffering from ectopic pregnancy in a previous caesarean section scar under the impression of Doppler ultrasound. Conservative regimen was first applied to one patient but failed to demonstrate enough efficacy. The b-HCG of the other patient was extremely high so conservative treatment was not considered. Then laparoscopic surgery was performed for the two patients and not only confirmed the diagnosis but also removed the ectopic gestational products successfully. The operation under laparoscopy was very smoothly. Total operation time was 80 minutes, blood loss was only about 100ml and blood transfusion was not necessary.