RESUMEN
OBJECTIVE: The aim of the study was to compare unplanned postoperative encounters in women discharged same day versus later after robotic-assisted sacrocolpopexy (RA-SCP). METHODS: This is a retrospective cohort study of women who underwent RA-SCP at a tertiary care center January 2013 to September 2015. Women were divided into 2 cohorts based on their day of discharge: (1) same day or (2) postoperative day 1 (POD ≥ 1) or later. Our primary outcome was unplanned provider visits (clinic, urgent care, emergency department, or hospital readmission) during the 6 weeks after surgery. Secondary outcomes included unplanned postdischarge nurse or physician phone calls. Logistic regression models were created to control for potential confounders. RESULTS: Two hundred seventy-two women were included; 80 underwent same-day discharge versus 192 discharged POD 1 or later (187 on POD 1, 5 on POD 2). Women discharged same day were older (61.3 vs 58.5 years, P < 0.05), more likely to have a start time before noon (85% vs 67.6%, P < 0.01), received less intraoperative intravenous fluids (1153 mL vs 1536 mL, P < 0.01), had shorter procedures (237 vs 256 minutes, P < 0.01), and spent more time in the postanesthesia care unit (213 vs 158 minutes, P < 0.01). There were no differences in unplanned provider visits between women discharged same day versus later (18.8% vs 27.6%, P = 0.12). No differences were observed in unplanned clinic visits, emergency department visits, or readmissions. In logistic regression models, unplanned provider visits (odds ratio = 0.35, 95% confidence interval = 0.30-1.54) and phone calls (odds ratio = 0.69, 95% confidence interval = 0.54-2.58) were not significantly different between groups. CONCLUSIONS: Same-day discharge after RA-SCP is safe and does not result in increased health care utilization (provider visits or postoperative phone calls).
Asunto(s)
Tiempo de Internación/estadística & datos numéricos , Alta del Paciente , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Robotizados , Vagina/cirugía , Anciano , Estudios de Cohortes , Urgencias Médicas , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , SacroRESUMEN
OBJECTIVES: To determine whether mixed-flora preoperative urine cultures, as compared with no-growth preoperative urine cultures, are associated with a higher prevalence of postoperative urinary tract infections (UTIs). METHODS: This was a retrospective cohort study. Women who underwent urogynecologic surgery were included if their preoperative clean-catch urine culture result was mixed flora or no growth. Women were excluded if they received postoperative antibiotics for reasons other than treatment of a UTI. Women were divided into two cohorts based on preoperative urine culture results-mixed flora or no growth; the prevalence of postoperative UTI was compared between cohorts. Baseline characteristics were compared using χ2 or Student t tests. A logistic regression analysis then was performed. RESULTS: We included 282 women who were predominantly postmenopausal, white, and overweight. There were many concomitant procedures; 46% underwent a midurethral sling procedure and 68% underwent pelvic organ prolapse surgery. Preoperative urine cultures resulted as mixed flora in 192 (68%) and no growth in 90 (32%) patients. Overall, 14% were treated for a UTI postoperatively. There was no difference in the proportion of patients treated for a postoperative UTI between the two cohorts (25 mixed flora vs 13 no growth, P = 0.77). These results remained when controlling for potentially confounding variables in a logistic regression model (adjusted odds ratio 0.92, 95% confidence interval 0.43-1.96). CONCLUSIONS: In women with mixed-flora compared with no-growth preoperative urine cultures, there were no differences in the prevalence of postoperative UTI. The clinical practice of interpreting mixed-flora cultures as negative is appropriate.
Asunto(s)
Complicaciones Posoperatorias , Infecciones Urinarias , Orina/microbiología , Anciano , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Prolapso de Órgano Pélvico/cirugía , Posmenopausia , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Cabestrillo Suburetral , UrinálisisRESUMEN
BACKGROUND: Robotic-assisted gynecologic surgery is common, but requires unique training. A validated assessment tool for evaluating trainees' robotic surgery skills is Robotic-Objective Structured Assessments of Technical Skills. OBJECTIVE: We sought to assess whether crowdsourcing can be used as an alternative to expert surgical evaluators in scoring Robotic-Objective Structured Assessments of Technical Skills. STUDY DESIGN: The Robotic Training Network produced the Robotic-Objective Structured Assessments of Technical Skills, which evaluate trainees across 5 dry lab robotic surgical drills. Robotic-Objective Structured Assessments of Technical Skills were previously validated in a study of 105 participants, where dry lab surgical drills were recorded, de-identified, and scored by 3 expert surgeons using the Robotic-Objective Structured Assessments of Technical Skills checklist. Our methods-comparison study uses these previously obtained recordings and expert surgeon scores. Mean scores per participant from each drill were separated into quartiles. Crowdworkers were trained and calibrated on Robotic-Objective Structured Assessments of Technical Skills scoring using a representative recording of a skilled and novice surgeon. Following this, 3 recordings from each scoring quartile for each drill were randomly selected. Crowdworkers evaluated the randomly selected recordings using Robotic-Objective Structured Assessments of Technical Skills. Linear mixed effects models were used to derive mean crowdsourced ratings for each drill. Pearson correlation coefficients were calculated to assess the correlation between crowdsourced and expert surgeons' ratings. RESULTS: In all, 448 crowdworkers reviewed videos from 60 dry lab drills, and completed a total of 2517 Robotic-Objective Structured Assessments of Technical Skills assessments within 16 hours. Crowdsourced Robotic-Objective Structured Assessments of Technical Skills ratings were highly correlated with expert surgeon ratings across each of the 5 dry lab drills (r ranging from 0.75-0.91). CONCLUSION: Crowdsourced assessments of recorded dry lab surgical drills using a validated assessment tool are a rapid and suitable alternative to expert surgeon evaluation.
Asunto(s)
Colaboración de las Masas , Evaluación Educacional/métodos , Procedimientos Quirúrgicos Ginecológicos/educación , Procedimientos Quirúrgicos Robotizados/educación , Entrenamiento Simulado , Competencia Clínica , Procedimientos Quirúrgicos Ginecológicos/normas , Humanos , India , Modelos Lineales , México , Variaciones Dependientes del Observador , Procedimientos Quirúrgicos Robotizados/normas , Estados Unidos , Grabación en VideoRESUMEN
INTRODUCTION AND HYPOTHESIS: Weight-loss has been demonstrated to result in an improvement in fecal incontinence (FI) severity; however, there is a paucity of data addressing the differential impact of FI on the quality of life (QOL) and results of diagnostic testing across BMI categories. We wished to evaluate symptom distress, QOL, and diagnostic testing parameters among normal, overweight, and obese women with fecal incontinence. METHODS: Women undergoing evaluation for FI between 2003 and 2012 were identified. Participants completed validated, symptom-specific distress, impact, and general QOL measures including the Modified Manchester Questionnaire (MMHQ), which includes the Fecal Incontinence Severity Index (FISI), and the mental and physical component summary scores, MCS and PCS, respectively, of the Short Form-12. Anorectal manometry measures were also included. Multivariate regression analyses were performed. RESULTS: Participants included 407 women with a mean age ± SD of 56 ± 13. Multivariate analyses revealed no differences in symptom-specific distress and impact as measured by MMHQ, MCS, and PCS across BMI groups; however, obese women had increased resting and squeeze pressures compared with normal and overweight BMI women (p < 0.0001 and p < 0.0001; p = 0.007 and p = 0.004 respectively). CONCLUSIONS: Obese women with FI did not have more general impact and symptom-specific distress and impact on quality of life compared with normal and overweight women. Obese women with FI had higher baseline anal resting and squeeze pressures suggesting a lower threshold to leakage with pressure increases.
Asunto(s)
Ansiedad/epidemiología , Ansiedad/psicología , Pruebas Diagnósticas de Rutina/psicología , Incontinencia Fecal/epidemiología , Incontinencia Fecal/psicología , Obesidad/complicaciones , Calidad de Vida/psicología , Adulto , Anciano , Índice de Masa Corporal , Estudios de Cohortes , Incontinencia Fecal/fisiopatología , Femenino , Humanos , Incidencia , Pruebas de Inteligencia , Manometría , Persona de Mediana Edad , Obesidad/fisiopatología , Obesidad/psicología , Sobrepeso/complicaciones , Sobrepeso/psicología , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine symptom-specific distress and quality-of-life impact outcomes among women who had undergone transvaginal repair of symptomatic rectocele. METHODS: Women who underwent transvaginal repair of symptomatic rectocele at the University of Alabama at Birmingham, USA, between April 2006 and June 2009 were included in a retrospective case series. Minimum follow-up was 1 year post-surgery. Women who underwent concomitant surgery, other than perineoplasty and/or midurethral sling, were excluded. End points were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS: Overall, 113 women underwent repair of symptomatic rectocele, of whom 69 (61.1%) completed preoperative questionnaires and 66 (58.4%) responded to follow-up questionnaires. Mean time from surgery was 31.2±11.2 months. PFDI-20 and PFIQ-7 scores were significantly improved following surgery, with a median pre- and post-surgery difference of 35.4 (P<0.001) and 31.0 (P=0.002), respectively. CONCLUSION: Patients who underwent transvaginal repair of symptomatic rectocele reported improvements in symptom-specific distress and impact on quality of life.