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Minaglia SM. Small Bowel Obstruction After Colpopexy-Case Report and Images of the Mechanism. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:457-460. [PMID: 37737744 DOI: 10.1097/spv.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Steven Michael Minaglia
- From the Queen's University Medical Group and John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
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Ingraham C, Makai G. Perioperative visits in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2023; 35:316-320. [PMID: 37266572 DOI: 10.1097/gco.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW Perioperative visits for gynecologic surgery patients have traditionally included in-person examinations and counseling, but the advent of telemedicine has prompted clinicians to consider varying approaches to perioperative care. We aim to educate readers on the optimal setting and context of perioperative visits and provide insight from our experience to optimize care. RECENT FINDINGS The widespread adoption of telemedicine and a focus on equity and access has prompted gynecologic surgeons to reconsider traditional preoperative and postoperative visits. SUMMARY This review summarizes evidence for new approaches to perioperative care for minimally invasive gynecologic surgery, including transition to telemedicine for preoperative and postoperative care, adjuvant tools for perioperative counseling, and the value of in-person visits for preoperative planning.
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Giusto LL, Derisavifard S, Zahner PM, Rueb JJ, Deyi L, Jiayi L, Weilin F, de Jesus Moreira R, Gomelsky A, Balzarro M, Goldman HB. Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial. Int Urogynecol J 2021; 33:1007-1015. [PMID: 33877376 PMCID: PMC8056194 DOI: 10.1007/s00192-021-04767-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/10/2021] [Indexed: 02/08/2023]
Abstract
Introduction and hypothesis The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement. Methods This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. The primary outcome was the rate of unplanned events. Secondary outcomes included patient satisfaction, crossover from telemedicine to office-based follow-up, and compliance with 3- to 5-month office follow-up. Results We included 238 patients (telemedicine: 121 vs office: 117). No differences in demographics or medical comorbidities were noted between the study groups (p = 0.09–1.0). No differences were noted in unplanned events: hospital admission, emergency department visit, or unplanned office visit or call (14% vs 12.9%, p = 0.85) or complications (9.9% vs 8.6%, p = 0.82). Both groups were equally “very satisfied” with their surgical outcomes (71.1% vs 69%, p = 0.2). Telemedicine patients were more compliant with 3- to 5-month office follow-up (90.1% vs 79.3%, p = 0.04). Conclusions After synthetic midurethral sling placement, telemedicine follow-up is a safe patient communication option in the early postoperative period. Telemedicine patients reported no difference in satisfaction compared with office-based follow-up but had greater compliance with 3- to 5-month follow-up.
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Affiliation(s)
- Laura L Giusto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Derisavifard
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patricia M Zahner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Jessica J Rueb
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luo Deyi
- West China Hospital of Sichuan University, Chengdu, China
| | - Li Jiayi
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fang Weilin
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | | | | | - Matteo Balzarro
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Howard B Goldman
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Clancy AA, Chen I, Pascali D, Minassian VA. Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using data from the National Surgical Quality Improvement Program Database (NSQIP). Int Urogynecol J 2020; 32:945-953. [PMID: 32840658 DOI: 10.1007/s00192-020-04505-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To define the reasons for hospital readmissions following surgery for pelvic organ prolapse by surgical approach. METHODS Patients undergoing surgery for pelvic organ prolapse from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology and International Classification of Diseases codes. Hazard risks of readmission by surgical approach (vaginal, laparoscopic, abdominal, or combined) were determined by multivariable cox regression. Diagnoses and timing of readmission by surgical approach were examined. RESULTS Of 57,233 women undergoing surgery for pelvic organ prolapse during the study period, 1073 (1.9%) were readmitted to the hospital within 30 days postoperatively. After adjusting for prespecified potential confounders, laparoscopic and abdominal surgical approaches were associated with higher risks of readmission relative to a vaginal approach (aHR 1.30, 95% CI 1.08-1.57, and 1.97, 95% CI 1.44-2.71, respectively). The most common reason for readmission was a gastrointestinal issue among those undergoing both laparoscopic (28.0%) and abdominal surgery (30.2%). Surgical site infection was the most common readmission diagnosis among women undergoing vaginal surgery (16.2%). Of the 418 women readmitted within 7 days of surgery, the most common diagnoses were gastrointestinal issues (26.6%), medical disorders (12.0%), or surgical complications (e.g., bleeding) (11.0%). CONCLUSIONS Women undergoing laparoscopic or abdominal surgery for pelvic organ prolapse were at higher risk of readmission relative to those undergoing surgery via a vaginal approach. The reasons and timing of readmission differed based on surgical approach.
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Affiliation(s)
- Aisling A Clancy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Urogynecology Clinic, The Ottawa Hospital Riverside Campus, 1967 Riverside Drive, Ottawa, ON, Canada.
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Innie Chen
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Urogynecology Clinic, The Ottawa Hospital Riverside Campus, 1967 Riverside Drive, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dante Pascali
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Urogynecology Clinic, The Ottawa Hospital Riverside Campus, 1967 Riverside Drive, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vatche A Minassian
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Foss Hansen M, Bóel Sigurdardòttir H, Oren Gradel K, Schiøler Kesmodel U, Lose G. A nationwide cohort study of hospital contacts after surgical treatment for urinary incontinence. Neurourol Urodyn 2019; 39:665-673. [PMID: 31782980 DOI: 10.1002/nau.24244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/16/2019] [Indexed: 11/11/2022]
Abstract
AIMS The aim was to assess complications of urinary incontinence (UI) for women who had a hospital contact within 30 days and to evaluate the conventional method of classifying complications vs grading complications into the Clavien-Dindo classification (CDC) system. METHODS A historical cohort study based on a nationwide population of women who had hospital contact within 30 days of surgical treatment for UI during a 5-year period. RESULTS There were 874 (16.2%) hospital contacts to the Department of Obstetrics and Gynecology, among 5393 procedures. For retropubic midurethral sling (RPMUS) and transobturator midurethral sling (TOMUS), the most common reasons for hospital contacts were voiding dysfunction, self-reported pain within 14 days and acute cystitis and for urethral injection therapy (UIT) persisting UI, acute cystitis, and voiding dysfunction. Voiding dysfunction requiring surgery, use of catheter or both, occurred more frequently in women who had RPMUS as compared with TOMUS (30.5% vs 21.7%; P = .01). Women, who received RPMUS and TOMUS, had surgical complications classified as up to CD IIIb, whereas women who had UIT were classified as up to CD II. CONCLUSIONS Sixteen percent of the women had a hospital contact within 30 days. A more obstructive character of RPMUS than for TOMUS was indicated, as more women with voiding dysfunction required surgery or catheter following RPMUS. The CDC system in its current form does not improve the overall characterization of complications in terms of type and severity following synthetic midurethral sling and UIT treatment.
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Affiliation(s)
- Margrethe Foss Hansen
- Center for Clinical Epidemiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hrefna Bóel Sigurdardòttir
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gunnar Lose
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial. Int Urogynecol J 2019; 30:1639-1646. [PMID: 30783704 DOI: 10.1007/s00192-019-03895-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to determine whether postoperative telephone follow-up was noninferior to in-person clinic visits based on patient satisfaction. Secondary outcomes were safety and clinical outcomes. METHODS Women scheduled for pelvic surgery were recruited from a single academic institution and randomized to clinic or telephone follow-up. The clinic group returned for visits 2, 6, and 12 weeks postoperatively and the telephone group received a call from a nurse at the same time intervals. Women completed the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) questionnaire, Pelvic Floor Distress Inventory (PFDI)-20, and pain scales prior to and 3 months postoperatively. Randomized patients who completed the S-CAHPS at 3 months were included for analysis. Sample size calculations, based on a 15% noninferiority limit in the S-CAHPS global assessment surgeon rating, required 100 participants, with power = 80% and alpha = 0.025. RESULTS From October 2016 to November 2017, 100 participants were consented, underwent surgery, were randomized, and included in the final analysis (clinic group n = 50, telephone group n = 50). Mean age was 58.5 ± 12.2 years. Demographic data and surgery type, dichotomized into outpatient and inpatient, did not differ between groups. The S-CAHPS global assessment surgeon rating from patients in the telephone group was noninferior to the clinic group (92 vs 88%, respectively, rated their surgeons 9 and10, with a noninferiority limit of 36.1; p = 0.006). Adverse events did not differ between groups (n = 26; 57% fclinic vs 43% telephone; p = 0.36). Patients in the telephone group did not require additional emergency room or primary care visits. Clinical outcome measures improved in both groups, with no differences (all p > 0.05). CONCLUSIONS Telephone follow-up after pelvic floor surgery results in noninferior patient satisfaction, without differences in clinical outcomes or adverse events. Telephone follow-up may improve healthcare quality and decrease patient and provider burden for postoperative care. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , www.clinicaltrials.gov , NCT02891187.
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