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Surgical Site Infection Reduction Initiative Following Abdominal Hysterectomy
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 589 The Morphological Features of the Proliferative Activity in Ectopic Endometrial Structures Sapargaliyeva A,1 Shumkova E,1 Yefimenko I,2 Cherepkova N,2 Imanbayeva Z,3 Dzhardemaliyeva N.3 1Department of Pathology, Kazakh National Medical University, Almaty, Kazakhstan; 2Laboratory of Pathology, Research Center for Obstetrics, Gynecology and Perinatology of the Republic of Kazakhstan, Almaty, Kazakhstan; 3Department of Residency in Obstetrics and Gynaecology, Kazakh National Medical University, Almaty, Kazakhstan Study Objective: It is known that focuses of endometriosis could be sources for development of endometrial adenocarcinoma in the ovaries, fallopian tubes and uterus, which indicates malignant transformation potential of glandular epithelium. Our study was aimed at analysis of morphological changes in the glandular epithelium to confirm their proliferative activity. Design: Materials and methods: We performed a retrospective analysis of 136 cases of morphologically confirmed endometriosis in tubes, ovaries and uterus. We analyzed morphological features by collecting tissues from patients (hospitalized in 2013-2014) who were subjected to hysterectomy for leiomyomas. The age group included patients from 35 to 50 years of age. Tissues were stained by hematoxylin and eosin and Van Gieson. Setting: All patients were treated at the Research Center for Obstetrics, Gynecology and Perinatology of the Republic of Kazakhstan (Almaty). Patients: Measurements and Main Results: High proliferative activity of glandular epithelium was manifested by new glandular structures (lacking lumen) formation; formation of true papillary structures in medium-sized glands, and formation of false papillae in the medium and large glands. At the same time, the activity of glandular epithelium persisted regardless of the sclerosis of stromal component. Conclusion: High proliferative activity of glandular epithelium was more common in cases of ovarian endometriosis, which allows us to consider the activity of the epithelium as a predictor for development of endometrioid cancer.
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Women were asked if they had any concerns about recovery after hysterectomy. Twenty six women stated that they had no concerns about recovery after hysterectomy. Eight women did not answer this question. Twenty three women expressed at least one concern about recovery after hysterectomy. The most common concern was the time it would take to recover and the second most common was sexual function following the procedure. Conclusion: The majority of women have general reservations about having surgery rather than individual risks associated with hysterectomy. Women with concerns are particularly worried about recovery time and sexual function following the procedure.
591 Unusual Branch of External Iliac Artery Pandey D,1 Huang KG,2 Lee C-L.2 1Ob/Gyn, KMC Manipal, Manipal, Karnataka, India; 2Ob/Gyn, Chang Gung Memorial Hospital, Taiwan, Taiwan Study Objective: The objective of this study is to report an unusual branch of external iliac artery which has never been reported before. Design: Case Report. Setting: Laparoscopic staging for endometrial carcinoma. Patients: 75-year-old lady with endometrial adenocarcinoma. Intervention: Laparoscopic staging. Later on contract CT. Measurements and Main Results: We report first time in English literature, case of an unusual branch of right external iliac artery in a 75-year-old patient during laparoscopic staging for endometrial adenocarcinoma. The unusual vessel (around 1.5 cm long) was arising at the junction of middle and distal thirds of external iliac artery (approximately 4.5 cm from the origin of external iliac artery), going towards the lateral pelvic wall. This artery appeared to be a muscular branch to the iliacus muscle.
590 Concerns and Expectations of Women Prior to Hysterectomy. A Cross-Sectional, Observational Study in Tauranga, New Zealand Chittenden B,1 Szmidt N.2 1Obstetrics and Gynaecology, Tauranga Provincial Hospital, Tauranga, Bay of Plenty, New Zealand; 2Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom Study Objective: The purpose of this project was to identify general topics of interest regarding patient concerns and expectations prior to hysterectomy which may be used to guide future audit and study. Design: This was a cross sectional observational study which used a paper questionnaire to collect quantitative and qualitative date from a cohort of women due to undergo hysterectomy between October 2014 and March 2015. Information collected will be used to shape future audit, identifying areas of concern for women as they undergo hysterectomy. Setting: A general district hospital in Tauranga, New Zealand. Patients: All women due to undergo Hysterectomy in Tauranga General Hospital were asked to take part in this evaluation while being counselled at their initial pre-hysterectomy consultation. Measurements and Main Results: A total of 57 women took part in the study. Women were asked whether they had any concerns about the procedure of hysterectomy. Thirty one women (54%) stated that they had no concerns about the procedure. Fourteen women did not answer this question. Of the women who expressed a concern about the procedure (n=12), the most commonly expressed concern was a concern about surgery in general rather than a specific aspect of hysterectomy.
Computed tomographic angiography later however proved it an obliterated vessel. Thus there is a possibility that this small vessel might be an embryological remnant. Conclusion: Awareness of this rare variation in branching of external iliac artery might be useful during pelvic lymphadenectomy.
592 Surgical Site Infection Reduction Initiative Following Abdominal Hysterectomy Nimaroff ML, Nahar D, Armellino D, Khameraj A. Obstetrics and Gynecology, North Shore LIJ, Manhasset, New York
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Study Objective: To review the incidence of surgical site infection following abdominal hysterectomy and discuss planned reduction initiative. Design: Retrospective Study. Setting: Academic Health Care System. Patients: All patients undergoing abdominal hysterectomies (including abdominal, laparoscopic, and robotic) in 2014. Intervention: All abdominal hysterectomies performed during 2014 from 10 health system hospital’s. Measurements and Main Results: The Center for Medicare and Medicaid Services (CMS) has initiated quality outcome metrics for surgical site infections following hysterectomy procedures. Beginning in 2016 missing CMS metrics (Standard Infection Ratio = SIR % 0.698) will lead to significant monetary penalties. A review of the 2014 data reported to the National Healthcare Safety Network was analyzed from 10 health system hospitals performing hysterectomies (5 tertiary, 5 community). 1851 abdominal hysterectomies were performed during the 12 month reporting period. A total of 30 surgical site infections were found for an incidence of 1.6%. The calculated expected number of infections was found to be 32.66 cases for an overall SIR=Observed Cases/Expected Case=0.92. 5/10 institutions were above the CMS threshold of 0.698 in 2014. A multidimensional SSI reduction initiative was put into place in 2015 which included education, identification of risk factors, accurate documentation in the record, and suggested surgical management. Management recommendations included preoperative antibacterial body wash, prophylactic antibiotics (repeating dose for prolonged procedures or with significant blood loss), discontinuing use of shavers, vaginal prepping for all cases, liberal use of wound protectors, and changing gloves and instruments for closure of the abdomen with wound class > 2. Conclusion: Though the incidence of SSI was found to be below expected numbers, 50% of the institutions were above the CMS SIR threshold of 0.698. Additional followup will be necessary to evaluate the effect of infection reduction methods.
Conclusion: Each of these drugs, Emla ointment and diclofenac gel can be used in reducing the pain of venipuncture.
594 Importance of Comprehensive Care Including Genetic Counseling for Ovary Carcinoma Patients by Gynecologic Oncologist Kim MK. Ob/Gyn, Sungkyunkwan University of Medicine, Samsung Changwon Hospital, Changwon-Si, California, Korea Study Objective: Hereditary breast and ovarian cancer (HBOC) are the most common hereditary cancer syndromes in ovary carcinoma. Genetic counseling and test after cancer diagnosis is important for detection and prevention of second cancer. The objective of this study was to investigate participation rate after early genetic counseling by surgeon among patients with ovary carcinoma patients. Design: This study examined 29 patients diagnosed with ovary carcinoma by single surgeon . All patients were provided genetic risk assessment counseling based on complete family history of cancer after one week of staging operation. Additionally, genetic sequencing to verify germ line mutations was performed after patient consent and obtained about one month after surgery. Setting:
593 The Effect of Emla Ointment and Diclofenac Gel in Reducing the Pain of Venipuncture in Parturient Women in Meshginshar, Iran Ghasemi M. Department of Biology, Ardabil Branch, Islamic Azad University, Ardabil, Islamic Republic of Iran Study Objective: Pain and its control are a problem in the world. Generally, intravenous injections, especially IV placement in veins often cause pain and discomfort for most patients. So the fear of pain and anxiety related to IV may lead to overall stress applied to the patient before surgery, hence it is so important to find ways to reduce the pain. Design: This study aimed to determine the effect of diclofenac and Emla cream on pain of venipuncture and IV in women admitted to hospital in Meshginshar, Iran, for normal vaginal delivery. This clinical trial, randomized was placebo-controlled. The samples were included 90 women and selected random-gradual based on the characteristics of the subjects and then randomly divided into three groups, diclofenac (A), Emla (B), control (C). Diclofenac gel, Emla ointment and Vaseline ointment were rubbed on group A, B and C an hour before venipuncture, respectively. Data were collected by personal information questionnaires, visual analogue scale (VAS) to measure pain intensity of IV and checklists of short-term possible side effects of the gel and ointments. Validity of the questionnaire was conducted by content validity and its reliability was conducted by the observer reliability. Data were analyzed using ANOVA, Duncan’s post- hoc test and Scheffe test. Patients: Measurements and Main Results: The results showed that the amount of pain caused by venipuncture using diclofenac and EMLA cream significantly was less than Vaseline ointment (P\ 0.01). Also significant differences were between diclofenac and EMLA cream, so that the least amount of pain was associated with the Emla group (P\ 0.01). Moreover, short-term side effects were not observed.
Patients: Ovary carcinoma patients. Intervention: Genetic counseling. Measurements and Main Results: Median age was 54.6(20w73). Advanced stage (IIIwIV) was 59 percent (17/29). About seventy percent had serous papillary adenocarcinoma (20/29). Preoperative CA 125 was 1444U/ml(11w16009). All patients received genetic risk assement counseling after one week of operation.3 patients refused after counseling.16 percent (4/29) of germline mutation patient were found. Six patients were found VUS(Variation of Unknown Significance). Two of germline mutation patients approved family sequencing. There were two germline mutation carriers among 1st degree relatives. Conclusion: Comprehensive treatment and early genetic counseling is feasible by gynecologic oncologist.Early counseling can enhance early detection of BRCA mutation carrier among ovary carcinoma patients family.
595 Assesment of the Intrafascial Total Laparoscopic Histerectomy in the Academic Environment Lob~ao ALG, Ferruzzi CM, Ohara F, Lima RF, Abdalla-Ribeiro HSA, Kuteken FS, Aldrighi JM, Ribeiro PAAG. Irmandade Da Santa Casa De Misericordia De S~ao Paulo, S~ao Paulo, Brazil
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Women were asked if they had any concerns about recovery after hysterectomy. Twenty six women stated that they had no concerns about recovery after hysterectomy. Eight women did not answer this question. Twenty three women expressed at least one concern about recovery after hysterectomy. The most common concern was the time it would take to recover and the second most common was sexual function following the procedure. Conclusion: The majority of women have general reservations about having surgery rather than individual risks associated with hysterectomy. Women with concerns are particularly worried about recovery time and sexual function following the procedure.
591 Unusual Branch of External Iliac Artery Pandey D,1 Huang KG,2 Lee C-L.2 1Ob/Gyn, KMC Manipal, Manipal, Karnataka, India; 2Ob/Gyn, Chang Gung Memorial Hospital, Taiwan, Taiwan Study Objective: The objective of this study is to report an unusual branch of external iliac artery which has never been reported before. Design: Case Report. Setting: Laparoscopic staging for endometrial carcinoma. Patients: 75-year-old lady with endometrial adenocarcinoma. Intervention: Laparoscopic staging. Later on contract CT. Measurements and Main Results: We report first time in English literature, case of an unusual branch of right external iliac artery in a 75-year-old patient during laparoscopic staging for endometrial adenocarcinoma. The unusual vessel (around 1.5 cm long) was arising at the junction of middle and distal thirds of external iliac artery (approximately 4.5 cm from the origin of external iliac artery), going towards the lateral pelvic wall. This artery appeared to be a muscular branch to the iliacus muscle.
590 Concerns and Expectations of Women Prior to Hysterectomy. A Cross-Sectional, Observational Study in Tauranga, New Zealand Chittenden B,1 Szmidt N.2 1Obstetrics and Gynaecology, Tauranga Provincial Hospital, Tauranga, Bay of Plenty, New Zealand; 2Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom Study Objective: The purpose of this project was to identify general topics of interest regarding patient concerns and expectations prior to hysterectomy which may be used to guide future audit and study. Design: This was a cross sectional observational study which used a paper questionnaire to collect quantitative and qualitative date from a cohort of women due to undergo hysterectomy between October 2014 and March 2015. Information collected will be used to shape future audit, identifying areas of concern for women as they undergo hysterectomy. Setting: A general district hospital in Tauranga, New Zealand. Patients: All women due to undergo Hysterectomy in Tauranga General Hospital were asked to take part in this evaluation while being counselled at their initial pre-hysterectomy consultation. Measurements and Main Results: A total of 57 women took part in the study. Women were asked whether they had any concerns about the procedure of hysterectomy. Thirty one women (54%) stated that they had no concerns about the procedure. Fourteen women did not answer this question. Of the women who expressed a concern about the procedure (n=12), the most commonly expressed concern was a concern about surgery in general rather than a specific aspect of hysterectomy.
Computed tomographic angiography later however proved it an obliterated vessel. Thus there is a possibility that this small vessel might be an embryological remnant. Conclusion: Awareness of this rare variation in branching of external iliac artery might be useful during pelvic lymphadenectomy.
592 Surgical Site Infection Reduction Initiative Following Abdominal Hysterectomy Nimaroff ML, Nahar D, Armellino D, Khameraj A. Obstetrics and Gynecology, North Shore LIJ, Manhasset, New York
S164
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Study Objective: To review the incidence of surgical site infection following abdominal hysterectomy and discuss planned reduction initiative. Design: Retrospective Study. Setting: Academic Health Care System. Patients: All patients undergoing abdominal hysterectomies (including abdominal, laparoscopic, and robotic) in 2014. Intervention: All abdominal hysterectomies performed during 2014 from 10 health system hospital’s. Measurements and Main Results: The Center for Medicare and Medicaid Services (CMS) has initiated quality outcome metrics for surgical site infections following hysterectomy procedures. Beginning in 2016 missing CMS metrics (Standard Infection Ratio = SIR % 0.698) will lead to significant monetary penalties. A review of the 2014 data reported to the National Healthcare Safety Network was analyzed from 10 health system hospitals performing hysterectomies (5 tertiary, 5 community). 1851 abdominal hysterectomies were performed during the 12 month reporting period. A total of 30 surgical site infections were found for an incidence of 1.6%. The calculated expected number of infections was found to be 32.66 cases for an overall SIR=Observed Cases/Expected Case=0.92. 5/10 institutions were above the CMS threshold of 0.698 in 2014. A multidimensional SSI reduction initiative was put into place in 2015 which included education, identification of risk factors, accurate documentation in the record, and suggested surgical management. Management recommendations included preoperative antibacterial body wash, prophylactic antibiotics (repeating dose for prolonged procedures or with significant blood loss), discontinuing use of shavers, vaginal prepping for all cases, liberal use of wound protectors, and changing gloves and instruments for closure of the abdomen with wound class > 2. Conclusion: Though the incidence of SSI was found to be below expected numbers, 50% of the institutions were above the CMS SIR threshold of 0.698. Additional followup will be necessary to evaluate the effect of infection reduction methods.
Conclusion: Each of these drugs, Emla ointment and diclofenac gel can be used in reducing the pain of venipuncture.
594 Importance of Comprehensive Care Including Genetic Counseling for Ovary Carcinoma Patients by Gynecologic Oncologist Kim MK. Ob/Gyn, Sungkyunkwan University of Medicine, Samsung Changwon Hospital, Changwon-Si, California, Korea Study Objective: Hereditary breast and ovarian cancer (HBOC) are the most common hereditary cancer syndromes in ovary carcinoma. Genetic counseling and test after cancer diagnosis is important for detection and prevention of second cancer. The objective of this study was to investigate participation rate after early genetic counseling by surgeon among patients with ovary carcinoma patients. Design: This study examined 29 patients diagnosed with ovary carcinoma by single surgeon . All patients were provided genetic risk assessment counseling based on complete family history of cancer after one week of staging operation. Additionally, genetic sequencing to verify germ line mutations was performed after patient consent and obtained about one month after surgery. Setting:
593 The Effect of Emla Ointment and Diclofenac Gel in Reducing the Pain of Venipuncture in Parturient Women in Meshginshar, Iran Ghasemi M. Department of Biology, Ardabil Branch, Islamic Azad University, Ardabil, Islamic Republic of Iran Study Objective: Pain and its control are a problem in the world. Generally, intravenous injections, especially IV placement in veins often cause pain and discomfort for most patients. So the fear of pain and anxiety related to IV may lead to overall stress applied to the patient before surgery, hence it is so important to find ways to reduce the pain. Design: This study aimed to determine the effect of diclofenac and Emla cream on pain of venipuncture and IV in women admitted to hospital in Meshginshar, Iran, for normal vaginal delivery. This clinical trial, randomized was placebo-controlled. The samples were included 90 women and selected random-gradual based on the characteristics of the subjects and then randomly divided into three groups, diclofenac (A), Emla (B), control (C). Diclofenac gel, Emla ointment and Vaseline ointment were rubbed on group A, B and C an hour before venipuncture, respectively. Data were collected by personal information questionnaires, visual analogue scale (VAS) to measure pain intensity of IV and checklists of short-term possible side effects of the gel and ointments. Validity of the questionnaire was conducted by content validity and its reliability was conducted by the observer reliability. Data were analyzed using ANOVA, Duncan’s post- hoc test and Scheffe test. Patients: Measurements and Main Results: The results showed that the amount of pain caused by venipuncture using diclofenac and EMLA cream significantly was less than Vaseline ointment (P\ 0.01). Also significant differences were between diclofenac and EMLA cream, so that the least amount of pain was associated with the Emla group (P\ 0.01). Moreover, short-term side effects were not observed.
Patients: Ovary carcinoma patients. Intervention: Genetic counseling. Measurements and Main Results: Median age was 54.6(20w73). Advanced stage (IIIwIV) was 59 percent (17/29). About seventy percent had serous papillary adenocarcinoma (20/29). Preoperative CA 125 was 1444U/ml(11w16009). All patients received genetic risk assement counseling after one week of operation.3 patients refused after counseling.16 percent (4/29) of germline mutation patient were found. Six patients were found VUS(Variation of Unknown Significance). Two of germline mutation patients approved family sequencing. There were two germline mutation carriers among 1st degree relatives. Conclusion: Comprehensive treatment and early genetic counseling is feasible by gynecologic oncologist.Early counseling can enhance early detection of BRCA mutation carrier among ovary carcinoma patients family.
595 Assesment of the Intrafascial Total Laparoscopic Histerectomy in the Academic Environment Lob~ao ALG, Ferruzzi CM, Ohara F, Lima RF, Abdalla-Ribeiro HSA, Kuteken FS, Aldrighi JM, Ribeiro PAAG. Irmandade Da Santa Casa De Misericordia De S~ao Paulo, S~ao Paulo, Brazil