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Lua-Mailland LL, Roversi G, Yao M, Ferrando CA. Healthcare Resource Utilization After Apical Prolapse Surgery in Women Who Received In-Office Versus Telephone-Only Preoperative Teaching. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00095. [PMID: 37093576 DOI: 10.1097/spv.0000000000001358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Despite increasing use of telehealth, no studies have evaluated telehealth use for preoperative teaching and its impact on healthcare resource utilization (HRU) after gynecologic surgery. OBJECTIVES This study aimed to compare HRU after apical prolapse surgery in women receiving in-office versus telephone-only preoperative teaching and identify factors associated with postoperative HRU. STUDY DESIGN A retrospective cohort study of women who underwent apical prolapse surgery from 2017 to 2020 at a tertiary referral center was conducted. Women were grouped based on the preoperative teaching type they received. Healthcare resource utilization was defined as a composite of patient-initiated calls, unscheduled outpatient visits, emergency department visits, and readmissions before the scheduled 6-week postoperative visit. Healthcare resource utilization was compared between in-office and telephone-only groups. Multivariable regression analysis was performed to identify factors associated with HRU. RESULTS A total of 1,168 women underwent in-office teaching, and 181 had telephone-only teaching. Of the 1,349 women, 980 (72.6%) had ≥1 HRU encounter and 222 (16.5%) had ≥5 HRU encounters within 6 weeks after surgery. There was no difference between telephone and office groups for composite outcomes of ≥1 HRU (78.5% vs 71.7%, P = 0.06) and ≥5 HRU (13.3% vs 17.0%, P = 0.21) encounters. A failed voiding trial was associated with a 4.4-fold increased risk of ≥5 encounters. Increasing age and body mass index, concomitant hysterectomy, and abdominal route were associated with a decreased likelihood of ≥5 encounters. CONCLUSIONS Three of 4 women had at least 1 unanticipated HRU encounter within 6 weeks after apical prolapse surgery. Preoperative teaching type was not associated with postoperative HRU. Telephone visits may be considered as an alternative to in-office visits for preoperative teaching.
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Affiliation(s)
- Lannah L Lua-Mailland
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic; and
| | - Gustavo Roversi
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic; and
| | - Meng Yao
- Department of Quantitative Health Sciences, Section of Biostatistics, Cleveland Clinic, Cleveland, Ohio
| | - Cecile A Ferrando
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic; and
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Ha B, Gordon T, Merchant M, Ramm O. Healthcare utilization following minimally invasive apical prolapse repair in a large integrated healthcare system. Int Urogynecol J 2021; 33:351-358. [PMID: 34132866 DOI: 10.1007/s00192-021-04884-x] [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: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to describe healthcare utilization (HU) following minimally invasive apical prolapse repair (MIAR) and its association with duration of hospital stay, patient characteristics, and perioperative factors. METHODS This retrospective study included women undergoing MIAR within a large managed care organization between January 1, 2011, and June 30, 2018, and aimed to quantify HU within 30 days of surgery. HU was dichotomized into two groups: normal and high, based on typical postoperative utilization of healthcare resources. The primary outcome was the rate of normal versus high HU overall and by duration of hospital stay [discharge home on day of surgery versus postoperative day (POD) 1-2]. Multivariable logistic regression was performed to identify factors predictive of high HU. A p value of < 0.05 was considered statistically significant. RESULTS Of the 4208 patients in our final cohort, 17% had high HU, while 83% were normal utilizers. High utilizers were more likely to have multiple comorbidities (p < 0.01) and a diagnosis of chronic pelvic pain (p = 0.02) and were less likely to be discharged on day of surgery (p < 0.01). A higher burden of disease, a concurrent mid-urethral sling or posterior colporrhaphy, and discharge on POD 1-2 were independently predictive of high HU. Within the high HU cohort, the most common type of unanticipated healthcare encounter was emergency department visit for urinary retention or pain. CONCLUSIONS Same-day discharge after MIAR does not result in increased HU, even after adjusting for relevant demographic and clinical characteristics. Pre-existing chronic pain diagnoses, multiple comorbidities, and concurrent mid-urethral sling are associated with high HU in this population.
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Affiliation(s)
- Barbara Ha
- Obstetrics & Gynecology, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Toya Gordon
- Female Pelvic Medicine & Reconstructive Surgery, Tower Health-Reading Hospital, West Reading, PA, USA
| | - Maqdooda Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Olga Ramm
- Female Pelvic Medicine & Reconstructive Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
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Barber MD, Brubaker L, Nygaard I, Wai CY, Dyer KY, Ellington D, Sridhar A, Gantz MG. Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol 2019; 221:233.e1-233.e16. [PMID: 31201809 PMCID: PMC7250460 DOI: 10.1016/j.ajog.2019.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. OBJECTIVE The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension. STUDY DESIGN This planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2-4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0-10 numeric rating scales; higher scores = greater pain) and Activity Assessment Scale (0-100; higher score = higher activity) prior to surgery and at 2 weeks, 4-6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role-physical subscales were used for this analysis (higher scores = less disability). Self-reported pain medication use was also collected. RESULTS Before surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P = .004, and +0.74, P = .007, respectively) and then decreased below baseline at 3 months (-0.87 and -1.14, respectively, P < .001), with no differences between surgical groups. Pain during exercise/strenuous activity and worst pain decreased below baseline levels at 4-6 weeks (-1.26, P = .014, and -0.95, P = .002) and 3 months (-1.97 and -1.50, P < .001) without differences between surgical groups. Functional activity as measured by the Activity Assessment Scale improved from baseline at 4-6 weeks (+9.24, P < .001) and 3 months (+13.79, P < .001). The MOS 36-item Short-Form Health Survey Bodily Pain, Physical Functioning, and Role-Physical Scales demonstrated significant improvements from baseline at 6, 12, and 24 months (24 months: +5.62, +5.79, and +4.72, respectively, P < .001 for each) with no differences between groups. Use of narcotic pain medications was reported by 14.3% of participants prior to surgery and 53.7% at 2 and 26.1% at 4-6 weeks postoperatively; thereafter use was similar to baseline rates until 24 months when it decreased to 6.8%. Use of nonnarcotic pain medication was reported by 48.1% of participants prior to surgery, 68.7% at 2 weeks, and similar to baseline at 3 months; thereafter use dropped steadily to 26.6% at 2 years. Uterosacral ligament suspension resulted in less new or worsening buttock pain than sacrospinous suspension at 4-6 weeks postoperatively (4.6% vs 10.5%, P = .043) but no difference in groin or thigh pain. CONCLUSION Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2-4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4-6 weeks.
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Affiliation(s)
- Matthew D Barber
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham NC.
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Diego, San Diego CA
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Clifford Y Wai
- Department of Obstetrics and Gynecology, University of Texas-Southwestern, Dallas TX
| | - Keisha Y Dyer
- Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, CA
| | - David Ellington
- Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham AL
| | - Amaanti Sridhar
- Department of Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
| | - Marie G Gantz
- Department of Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC
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Vancaillie T, Tan Y, Chow J, Kite L, Howard L. Pain after vaginal prolapse repair surgery with mesh is a post-surgical neuropathy which needs to be treated - and can possibly be prevented in some cases. Aust N Z J Obstet Gynaecol 2018; 58:696-700. [PMID: 29577243 PMCID: PMC6585787 DOI: 10.1111/ajo.12804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
Post-surgical neuropathy leading to chronic pain is a recognised complication. It also can occur after surgery for pelvic organ prolapse repair involving mesh. Post-surgical neuropathy needs to be identified and properly treated to minimise the occurrence of chronic pain. A treatment algorithm is put forward for discussion .
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Affiliation(s)
- Thierry Vancaillie
- Department of Women's and Children, University of New South Wales, Sydney, New South Wales, Australia.,Royal Hospital for Women, Sydney, New South Wales, Australia.,Women's Health & Research Institute of Australia, Sydney, New South Wales, Australia
| | - Yasmin Tan
- Women's Health & Research Institute of Australia, Sydney, New South Wales, Australia.,Vulval Health Clinic, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Chow
- Women's Health & Research Institute of Australia, Sydney, New South Wales, Australia.,Chronic pelvic pain clinic, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lauren Kite
- Women's Health & Research Institute of Australia, Sydney, New South Wales, Australia.,Chronic pelvic pain clinic, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Liz Howard
- Women's Health & Research Institute of Australia, Sydney, New South Wales, Australia.,Osteopath, Pain Management, Education and Support, Women's Health & Research Institute of Australia, Sydney, New South Wales, Australia
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Tobar Roa V, Gómez M, González A, Zableh A. Neuropatía del pudendo como causa de dolor pélvico. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ResumenEl síndrome de atrapamiento del nervio pudendo es una de múltiples causas de dolor pélvico crónico. Hemos realizado una revisión de la literatura sobre su presentación clínica, diagnóstico y tratamiento, con el propósito de conocer los detalles más relevantes de una enfermedad que cada vez está siendo más diagnosticada, con el fin de realizar un abordaje precoz desde un punto de vista integral.
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Affiliation(s)
- Verónica Tobar Roa
- Universidad Autónoma de Bucaramanga; Uróloga Pontificia Universidad Javeriana; Máster Universitario de Investigación Clínica en Donación y Trasplante de Órganos, Tejidos y Células, Universidad de Barcelona; Uróloga, Centro Urológico Foscal, Floridablanca, Santander, Colombia
| | - María Gómez
- Universidad Industrial de Santander; Anestesióloga, Universidad Militar Nueva Granada; Fellow Anestesia Regional guiada por Ultrasonido programa CLASA-WFSA-SBA; Anestesióloga Sociedad Especializada de Anestesiología SEA S.A., Clínica Carlos Ardila Lulle, Floridablanca, Santander, Colombia
| | - Ana González
- Universidad Autónoma de Bucaramanga; Residente de Segundo año de Urología, Universidad Autónoma de Bucaramanga, Floridablanca, Santander, Colombia
| | - Ana Zableh
- Interna, Pontificia Universidad Javeriana, Bogotá, Colombia
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Paz-Levy D, Yohay D, Neymeyer J, Hizkiyahu R, Weintraub AY. Native tissue repair for central compartment prolapse: a narrative review. Int Urogynecol J 2016; 28:181-189. [PMID: 27209309 DOI: 10.1007/s00192-016-3032-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
Central descent due to a level 1 defect is a main component in pelvic organ prolapse (POP) reconstructive surgery, whether for symptomatic apical prolapse or for the prolapse repair of other compartments. A recent growth in the rate of native tissue repair procedures for POP, following the US Food and Drug Administration (FDA) warnings regarding the safety and efficacy of synthetic meshes, requires a re-evaluation of these procedures. The safety, efficacy, and determination of the optimal surgical approach should be the center of attention. Functional outcome measures and patient-centered results have lately gained importance and received focus. A comprehensive literature review was performed to evaluate objective and subjective outcomes of apical prolapse native tissue repair, with a special focus on studies reporting impact on patients' functional outcomes, quality of life, and satisfaction. We performed a MEDLINE search for articles in the English language by using the following key words: apical prolapse, sacrospinous ligament fixation, uterosacral ligament suspension, sacral colpopexy, McCall culdoplasty, iliococcygeus vaginal fixation, and functional outcomes. We reviewed references as well. Despite a prominent shortage of studies reporting standardized prospective outcomes for native tissue repair interventions, we noted a high rate of safety and efficacy, with a low complication rate for most procedures and low recurrence or re-treatment rates. The objective and subjective results of different procedures are reviewed. Functional outcomes of native tissue repair procedures have not been studied sufficiently, though existing data present those procedures as favorable and not categorically inferior to sacrocolpopexy. Apical compartment prolapse repair using native tissue is not a compromise. Functional outcomes of native tissue repair procedures are favorable, have a high rate of success, improve women's quality of life (QoL), and result in high rates of patient satisfaction. This subject requires further long-term, standardized prospective studies following the International Continence Society/International Urogynecologists Association guidelines for surgical outcomes report, with the focus on patient-centered functional outcomes.
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Affiliation(s)
- Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joerg Neymeyer
- Department of Urology, Charitè University, Berlin, Germany
| | - Ranit Hizkiyahu
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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