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Trends in the Surgical Management of Ectopic Pregnancy with the Addition of MIS Faculty
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 196
Open Communications 17 – Laparoscopy (3:25 PM - 5:05 PM) 4:11 PM – GROUP B
Effect of Length of Stay on Infection and Readmission Following Laparoscopic Hysterectomy Schiff LD,1 Strassle PD,2 Dizon AM,1 Carey ET,1 Moulder JK,1 Louie M1. 1 Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 2 Epidemiology, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Study Objective: To assess the effect of length of stay on postoperative outcomes of infection and readmission following laparoscopic hysterectomy. Design: Retrospective cohort study of prospectively collected quality improvement data. Setting: American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database and NSQIP targeted data files, including patient information and 30-day postoperative outcomes from over 500 hospitals as well as procedure-specific risk factors and outcomes in a subset of participating hospitals. Patients: Women undergoing laparoscopic hysterectomy, identified by Current Procedural Terminology codes, for benign conditions from 2014 to 2015 were eligible for inclusion. Patients with gynecologic cancer, whose surgery was performed by a non-gynecology specialist, who were discharged >1 day after surgery, or who were not in the targeted data files were excluded. Intervention: 30-day post-operative infection and readmission were compared between women discharged the same day after laparoscopic hysterectomy and those discharged on post-operative day 1. Measurements and Main Results: Multivariable logistic regression was used for analysis of 14,059 patients adjusting for demographic, medical comorbidities, surgical history, and procedure variables. After adjusting for patient demographics and both medical and procedure variables, no significant differences in the odds of surgical site infection or urinary tract infection were seen among patients with same day discharge, aOR 0.80 (95% CI 0.54, 1.17), p = .25, and aOR 0.95 (95% CI 0.69, 1.21), p = .74, respectively. Same day discharge may be associated with reduced odds for readmission, aOR 0.73 (95% CI 0.52, 1.03), p = .07. Conclusion: There is no significant difference in risk of infection or 30day readmission following same day discharge and discharge postoperative day one after laparoscopic hysterectomy. Laparoscopic hysterectomy patients may be discharged on the same day of surgery without increasing post-operative infections or readmissions.
197
Open Communications 17 – Laparoscopy (3:25 PM - 5:05 PM) 4:18 PM – GROUP B
Trends in the Surgical Management of Ectopic Pregnancy with the Addition of MIS Faculty Moawad N,1 Baker S,2 Hergert S,2 Shuster J,3 Robinson M4. 1Section of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida; 2University of Florida College of Medicine, Gainesville, Florida; 3 Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, Florida; 4Department of Biostatistics, University of Florida College of Medicine, Gainesville, Florida Study Objective: To assess the trend towards minimally invasive surgical management of ectopic pregnancies at a university-affiliated Ob/Gyn residency program with the establishment of a Minimally Invasive Gynecologic Surgery (MIGS) Section with fellowship-trained faculty. Design: Retrospective study of patients who required surgical management for ectopic pregnancy. The surgical approach and study population were compared between the period of 8/2010 - 7/2015 (after the establishment
S81
of a MIGS section) and the period of 8/2005 - 7/2010 (before the establishment of a MIGS Section). Setting: University-affiliated Ob/Gyn residency program, within a tertiary care facility. Patients: A total of 270 patients who underwent surgical management for ectopic pregnancy during the study period. Intervention: The hospital database was searched using cpt codes for surgical procedures used for the management of ectopic pregnancy. A chart review was completed, collecting patient characteristics, date of the procedure, surgical approach, specialty of primary surgeon and surgical outcomes. Measurements and Main Results: Two hundred and seventy patients underwent surgical management of ectopic pregnancy during the study period. Group A (before the establishment of a MIGS Section 8/2005 - 7/2010) included 116 patients, 49 of whom were treated laparoscopically (42%). Group B (after the establishment of a MIGS Section 8/2010 - 7/2015) included 154 patients, 119 of whom were treated laparoscopically (77.3%). Statistical analysis using Mantel-Haenszel test revealed a statistically significant increase in the utilization of minimally invasive surgery for ectopic pregnancy as the standard of care. The odds ratio of treating ectopic pregnancy laparoscopically after the addition of a MIGS section is estimated at 4.6 (95% CI from 2.7 to 7.9) with a p value of <0.001. Conclusion: The adoption of laparoscopy in the surgical management of ectopic pregnancy has significantly increased with the establishment of a Minimally Invasive Gynecologic Surgery Section in a university-affiliated tertiary care hospital.
198
Open Communications 17 – Laparoscopy (3:25 PM - 5:05 PM) 4:29 PM – GROUP C
Effect of Body Mass Index on Reoperation Following Hysterectomy Dizon M,1 Strassle PD,2 Schiff LD,1 Louie M,1 Carey ET,1 Moulder JK1. 1 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; 2Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina Study Objective: Assess association of body mass index (BMI) on risk of reoperation following hysterectomy. Design: Retrospective cohort study of prospectively collected surgical quality improvement data. Setting: American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, containing voluntarily submitted patient demographic and perioperative information, and 30-day postoperative outcomes from over 500 hospitals and the targeted data files, which includes procedure-specific risk factors and outcomes available for a subset of participating hospitals. Patients: Patients undergoing abdominal, vaginal, or laparoscopic hysterectomy, identified with Current Procedural Terminology (CPT) codes, for benign indications from 2014–2015 were eligible. Patients with cancer, with surgery not performed by a gynecologist, not in the targeted files, or who were missing BMI were excluded. Intervention: Patients undergoing hysterectomy were compared with respect to 30-day postoperative reoperation and BMI. Measurements and Main Results: 28,487 patients met inclusion criteria. Multivariable logistic regression was used for analysis; BMI was treated as a quadratic variable. After adjusting for patient and surgical characteristics, compared to a BMI of 24 kg/m2, increased BMIs of 29 (aOR 0.83, 95% CI 0.74, 0.94, p = .003), 34 (aOR 0.75, 95% CI 0.61, 0.92, p = .005) and 39 (aOR 0.73, 95% CI 0.56, 0.95, p = .02) were significantly associated with a lower odds of reoperation. However, a low normal BMI of 18.5 was associated with increased odds of reoperation (aOR 1.33, 95% CI 1.12, 1.58, p = .001). Conclusion: Patient characteristics and medical and surgical factors contribute to reoperation after hysterectomy in this large sample. Contrary to previous data, increasing BMI, independent of medical and surgical factors,
Open Communications 17 – Laparoscopy (3:25 PM - 5:05 PM) 4:11 PM – GROUP B
Effect of Length of Stay on Infection and Readmission Following Laparoscopic Hysterectomy Schiff LD,1 Strassle PD,2 Dizon AM,1 Carey ET,1 Moulder JK,1 Louie M1. 1 Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 2 Epidemiology, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Study Objective: To assess the effect of length of stay on postoperative outcomes of infection and readmission following laparoscopic hysterectomy. Design: Retrospective cohort study of prospectively collected quality improvement data. Setting: American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database and NSQIP targeted data files, including patient information and 30-day postoperative outcomes from over 500 hospitals as well as procedure-specific risk factors and outcomes in a subset of participating hospitals. Patients: Women undergoing laparoscopic hysterectomy, identified by Current Procedural Terminology codes, for benign conditions from 2014 to 2015 were eligible for inclusion. Patients with gynecologic cancer, whose surgery was performed by a non-gynecology specialist, who were discharged >1 day after surgery, or who were not in the targeted data files were excluded. Intervention: 30-day post-operative infection and readmission were compared between women discharged the same day after laparoscopic hysterectomy and those discharged on post-operative day 1. Measurements and Main Results: Multivariable logistic regression was used for analysis of 14,059 patients adjusting for demographic, medical comorbidities, surgical history, and procedure variables. After adjusting for patient demographics and both medical and procedure variables, no significant differences in the odds of surgical site infection or urinary tract infection were seen among patients with same day discharge, aOR 0.80 (95% CI 0.54, 1.17), p = .25, and aOR 0.95 (95% CI 0.69, 1.21), p = .74, respectively. Same day discharge may be associated with reduced odds for readmission, aOR 0.73 (95% CI 0.52, 1.03), p = .07. Conclusion: There is no significant difference in risk of infection or 30day readmission following same day discharge and discharge postoperative day one after laparoscopic hysterectomy. Laparoscopic hysterectomy patients may be discharged on the same day of surgery without increasing post-operative infections or readmissions.
197
Open Communications 17 – Laparoscopy (3:25 PM - 5:05 PM) 4:18 PM – GROUP B
Trends in the Surgical Management of Ectopic Pregnancy with the Addition of MIS Faculty Moawad N,1 Baker S,2 Hergert S,2 Shuster J,3 Robinson M4. 1Section of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida; 2University of Florida College of Medicine, Gainesville, Florida; 3 Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, Florida; 4Department of Biostatistics, University of Florida College of Medicine, Gainesville, Florida Study Objective: To assess the trend towards minimally invasive surgical management of ectopic pregnancies at a university-affiliated Ob/Gyn residency program with the establishment of a Minimally Invasive Gynecologic Surgery (MIGS) Section with fellowship-trained faculty. Design: Retrospective study of patients who required surgical management for ectopic pregnancy. The surgical approach and study population were compared between the period of 8/2010 - 7/2015 (after the establishment
S81
of a MIGS section) and the period of 8/2005 - 7/2010 (before the establishment of a MIGS Section). Setting: University-affiliated Ob/Gyn residency program, within a tertiary care facility. Patients: A total of 270 patients who underwent surgical management for ectopic pregnancy during the study period. Intervention: The hospital database was searched using cpt codes for surgical procedures used for the management of ectopic pregnancy. A chart review was completed, collecting patient characteristics, date of the procedure, surgical approach, specialty of primary surgeon and surgical outcomes. Measurements and Main Results: Two hundred and seventy patients underwent surgical management of ectopic pregnancy during the study period. Group A (before the establishment of a MIGS Section 8/2005 - 7/2010) included 116 patients, 49 of whom were treated laparoscopically (42%). Group B (after the establishment of a MIGS Section 8/2010 - 7/2015) included 154 patients, 119 of whom were treated laparoscopically (77.3%). Statistical analysis using Mantel-Haenszel test revealed a statistically significant increase in the utilization of minimally invasive surgery for ectopic pregnancy as the standard of care. The odds ratio of treating ectopic pregnancy laparoscopically after the addition of a MIGS section is estimated at 4.6 (95% CI from 2.7 to 7.9) with a p value of <0.001. Conclusion: The adoption of laparoscopy in the surgical management of ectopic pregnancy has significantly increased with the establishment of a Minimally Invasive Gynecologic Surgery Section in a university-affiliated tertiary care hospital.
198
Open Communications 17 – Laparoscopy (3:25 PM - 5:05 PM) 4:29 PM – GROUP C
Effect of Body Mass Index on Reoperation Following Hysterectomy Dizon M,1 Strassle PD,2 Schiff LD,1 Louie M,1 Carey ET,1 Moulder JK1. 1 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; 2Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina Study Objective: Assess association of body mass index (BMI) on risk of reoperation following hysterectomy. Design: Retrospective cohort study of prospectively collected surgical quality improvement data. Setting: American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, containing voluntarily submitted patient demographic and perioperative information, and 30-day postoperative outcomes from over 500 hospitals and the targeted data files, which includes procedure-specific risk factors and outcomes available for a subset of participating hospitals. Patients: Patients undergoing abdominal, vaginal, or laparoscopic hysterectomy, identified with Current Procedural Terminology (CPT) codes, for benign indications from 2014–2015 were eligible. Patients with cancer, with surgery not performed by a gynecologist, not in the targeted files, or who were missing BMI were excluded. Intervention: Patients undergoing hysterectomy were compared with respect to 30-day postoperative reoperation and BMI. Measurements and Main Results: 28,487 patients met inclusion criteria. Multivariable logistic regression was used for analysis; BMI was treated as a quadratic variable. After adjusting for patient and surgical characteristics, compared to a BMI of 24 kg/m2, increased BMIs of 29 (aOR 0.83, 95% CI 0.74, 0.94, p = .003), 34 (aOR 0.75, 95% CI 0.61, 0.92, p = .005) and 39 (aOR 0.73, 95% CI 0.56, 0.95, p = .02) were significantly associated with a lower odds of reoperation. However, a low normal BMI of 18.5 was associated with increased odds of reoperation (aOR 1.33, 95% CI 1.12, 1.58, p = .001). Conclusion: Patient characteristics and medical and surgical factors contribute to reoperation after hysterectomy in this large sample. Contrary to previous data, increasing BMI, independent of medical and surgical factors,