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McCormack L, Song S, Budden A, Ma C, Nguyen K, Li FG, Lim CY, Maheux-Lacroix S, Arnold A, Deans R, Won HR, Knapman B, Nesbitt-Hawes E, Abbott JA. Immediate versus delayed urinary catheter removal following non-hysterectomy benign gynaecological laparoscopy: a randomised trial. BJOG 2023; 130:1112-1119. [PMID: 36852512 DOI: 10.1111/1471-0528.17442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To compare rates of urinary retention and postoperative urinary tract infection between women with immediate versus women with delayed removal of indwelling catheter following benign non-hysterectomy gynaecological laparoscopic surgery. DESIGN This randomised clinical trial was conducted between February 2012 and December 2019, with follow-up to 6 weeks. SETTING Two university-affiliated teaching hospitals in Sydney, Australia. POPULATION Study participants were 693 women aged 18 years or over, undergoing non-hysterectomy laparoscopy for benign gynaecological conditions, excluding pelvic floor or concomitant bowel surgery. METHODS Three hundred and fifty-five participants were randomised to immediate removal of urinary catheter and 338 participants were randomised to delayed removal of urinary catheter. MAIN OUTCOME MEASURES The co-primary outcomes were urinary retention and urinary tract infection. Secondary outcomes included hospital readmission, analgesia requirements, duration of hospitalisation and validated bladder function questionnaires. RESULTS Urinary retention was higher after immediate compared with delayed removal of the urinary catheter (8.2% vs 4.2%, RR 1.8, 95% CI 1.0-3.0, p = 0.04). Although urinary tract infection was 7.2% following delayed removal of the urinary catheter and 4.7% following immediate removal of the urinary catheter, the difference was not statistically significant (RR 0.7, 95% CI 0.3-1.2, p = 0.2). CONCLUSIONS There is an increased risk of urinary retention with the immediate compared with the delayed removal of the urinary catheter following benign non-hysterectomy gynaecological laparoscopic surgery. The difference in urinary tract infection was not significant. There is 1/12 risk of re-catheterisation after immediate urinary catheter removal. It is important to ensure that patients report normal voiding and emptying prior to discharge, to reduce the need for readmission for the management of urinary retention.
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Affiliation(s)
- Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sophia Song
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Aaron Budden
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Christine Ma
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Fiona G Li
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Claire Y Lim
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Amy Arnold
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Ha Ryun Won
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Mason EM, Henderson WG, Bronsert MR, Colborn KL, Dyas AR, Lambert-Kerzner A, Meguid RA. Development and validation of a multivariable preoperative prediction model for postoperative length of stay in a broad inpatient surgical population. Surgery 2023; 174:66-74. [PMID: 37149424 PMCID: PMC10272088 DOI: 10.1016/j.surg.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/16/2023] [Accepted: 02/23/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Postoperative length of stay is a meaningful patient-centered outcome and an important determinant of healthcare costs. The Surgical Risk Preoperative Assessment System preoperatively predicts 12 postoperative adverse events using 8 preoperative variables, but its ability to predict postoperative length of stay has not been assessed. We aimed to determine whether the Surgical Risk Preoperative Assessment System variables could accurately predict postoperative length of stay up to 30 days in a broad inpatient surgical population. METHODS This was a retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program adult database from 2012 to 2018. A model using the Surgical Risk Preoperative Assessment System variables and a 28-variable "full" model, incorporating all available American College of Surgeons' National Surgical Quality Improvement Program preoperative nonlaboratory variables, were fit to the analytical cohort (2012-2018) using multiple linear regression and compared using model performance metrics. Internal chronological validation of the Surgical Risk Preoperative Assessment System model was conducted using training (2012-2017) and test (2018) datasets. RESULTS We analyzed 3,295,028 procedures. The adjusted R2 for the Surgical Risk Preoperative Assessment System model fit to this cohort was 93.3% of that for the full model (0.347 vs 0.372). In the internal chronological validation of the Surgical Risk Preoperative Assessment System model, the adjusted R2 for the test dataset was 97.1% of that for the training dataset (0.3389 vs 0.3489). CONCLUSION The parsimonious Surgical Risk Preoperative Assessment System model can preoperatively predict postoperative length of stay up to 30 days for inpatient surgical procedures almost as accurately as a model using all 28 American College of Surgeons' National Surgical Quality Improvement Program preoperative nonlaboratory variables and has shown acceptable internal chronological validation.
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Affiliation(s)
- Emily M Mason
- Clinical Science Program, University of Colorado Anschutz Medical Campus, Graduate School, Colorado Clinical and Translational Sciences Institute, Aurora, CO.
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO
| | - Adam R Dyas
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO.
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Chen Y, Zhu Y, Zhong K, Yang Z, Li Y, Shu X, Wang D, Deng P, Bai X, Gu J, Lu K, Zhang J, Zhao L, Zhu T, Wei K, Yi B. Optimization of anesthetic decision-making in ERAS using Bayesian network. Front Med (Lausanne) 2022; 9:1005901. [PMID: 36186765 PMCID: PMC9519180 DOI: 10.3389/fmed.2022.1005901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) can accelerate patient recovery. However, little research has been done on optimizing the ERAS-related measures and how the measures interact with each other. The Bayesian network (BN) is a graphical model that describes the dependencies between variables and is also a model for uncertainty reasoning. In this study, we aimed to develop a method for optimizing anesthetic decisions in ERAS and then investigate the relationship between anesthetic decisions and outcomes. First, assuming that the indicators used were independent, the effects of combinations of single indicators were analyzed based on BN. Additionally, the impact indicators for outcomes were selected with statistical tests. Then, based on the previously selected indicators, the Bayesian network was constructed using the proposed structure learning method based on Strongly Connected Components (SCC) Local Structure determination by Hill Climbing Twice (LSHCT) and adjusted according to the expert’s knowledge. Finally, the relationship is analyzed. The proposed method is validated by the real clinical data of patients with benign gynecological tumors from 3 hospitals in China. Postoperative length of stay (LOS) and total cost (TC) were chosen as the outcomes. Experimental results show that the ERAS protocol has some pivotal indicators influencing LOS and TC. Identifying the relationship between these indicators can help anesthesiologists optimize the ERAS protocol and make individualized decisions.
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Affiliation(s)
- Yuwen Chen
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences (CAS), Chongqing, China
| | - Yiziting Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kunhua Zhong
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences (CAS), Chongqing, China
| | - Zhiyong Yang
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yujie Li
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xin Shu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Dandan Wang
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Peng Deng
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xuehong Bai
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jianteng Gu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Kaizhi Lu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ju Zhang
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences (CAS), Chongqing, China
| | - Lei Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ke Wei
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Ke Wei,
| | - Bin Yi
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Bin Yi,
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Shu M, Sosa J, Reyes HD, Eddib A, Eswar A. The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult. Curr Opin Obstet Gynecol 2022; 34:190-195. [PMID: 35895960 DOI: 10.1097/gco.0000000000000795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Minimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic disorders. To date, no formal recommendations have been made in defining a referral system for MIGS. This article reviews the evidence regarding common disorders and procedures and their outcomes, and posits a basis for MIGS referral. RECENT FINDINGS In instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes, and therefore, benefit from the skills of MIGS subspecialists: fibroids - at least five myomas, myoma size at least 9 cm, and suspected myoma weight at least 500 g; endometriosis - presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; hysterectomy - uteri at least 250 g or 12 weeks estimated size, at least three prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. SUMMARY A referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.
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Affiliation(s)
- Michael Shu
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
| | - J'Leise Sosa
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- GPPC Women's Health, Buffalo
| | - Henry D Reyes
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Great Lakes Cancer Care
| | - Abeer Eddib
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Western New York Urology Associates, Amherst
| | - Alexander Eswar
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Invision Health, Williamsville, New York, USA
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Oxley SG, Mallick R, Odejinmi F. Laparoscopic Myomectomy: An Alternative Approach to Tackling Submucous Myomas? J Minim Invasive Gynecol 2019; 27:155-159. [PMID: 30926366 DOI: 10.1016/j.jmig.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To evaluate the differences in perioperative outcomes and immediate complication rates between laparoscopic myomectomy for submucous myomas and laparoscopic myomectomy for myomas in other locations. DESIGN Retrospective cohort study. SETTING University-affiliated hospital in London. PATIENTS A total of 350 patients with symptomatic uterine myomas underwent laparoscopic myomectomy. Thirty-three of these were performed for submucous myomas (group 1), and 317 were for myomas in other uterine locations (group 2). INTERVENTIONS Analysis of prospectively collected data on patient demographics, myoma characteristics, perioperative outcomes, and immediate complications. MEASUREMENTS AND MAIN RESULTS Patient demographics, including age, body mass index, and parity, were similar in the 2 groups. No significant differences in myoma characteristics were seen between groups 1 and 2, including the mean dimension of largest myoma (7.1 vs 7.8 cm, respectively; p = .35), mean number of myomas removed (3.8 vs 4.1; p = .665), and mean mass of myomas removed (142.0 g vs 227.3 g; p = .186). There were also no significant between-group differences in any perioperative outcomes, including mean blood loss (226.8 mL vs 266.4 mL; p = .373), duration of surgery (103 minutes vs 113 minutes; p = .264), and duration of hospital stay (1.4 days vs 1.7 days; p = .057). No complications arose from laparoscopic resection of submucous myomas. CONCLUSION Laparoscopic myomectomy for submucous myomas has similar perioperative outcomes and immediate complications as laparoscopic myomectomy for other myomas and can be considered for large or type 2 submucous myomas.
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Affiliation(s)
- Samuel George Oxley
- Department of Women's Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi).
| | - Rebecca Mallick
- Department of Women's Health, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Haywards Heath, United Kingdom (Dr. Mallick)
| | - Funlayo Odejinmi
- Department of Women's Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi)
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