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Nutaitis AC, George EL, Mangira CJ, Wallace SL, Bowersox NA. Trends in Urogynecologic Surgery Among Obstetrics and Gynecology Residents From 2002 to 2022. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:73-79. [PMID: 37428884 DOI: 10.1097/spv.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
IMPORTANCE The number of American women with a pelvic floor disorder is projected to increase from 28.1 million in 2010 to 43.8 million in 2050. OBJECTIVES The objective of this study was to evaluate trends in the number of urogynecologic procedures performed by graduating obstetrics and gynecology residents and to compare variability in volume between residents in the 70th and 30th percentiles for logged cases. STUDY DESIGN National case log measures for residents who graduated between 2003 and 2022 were reviewed. Mean case numbers and variability in case numbers were analyzed over time. RESULTS Data were collected from a median of 1,216.5 residents (range, 1,090 to 1,427) annually. Mean number of vaginal hysterectomies logged per resident decreased by 46.4% from 2002/2003 to 2021/2022 ( P = 0.0007). Mean number of urogynecology procedures increased by 1,165.5% from 2002/2003 to 2007/2008 ( P = 0.0015). Mean number of incontinence and pelvic floor procedures (including cystoscopies) increased by 190.9% from 2002/2003 to 2011/2012 ( P = 0.0002). Mean number of incontinence and pelvic floor procedures (excluding cystoscopies) decreased by 39.7% from 2012/2013 to 2021/2022 ( P < 0.0001). Mean number of cystoscopies increased by 19.7% from 2012/2013 to 2021/2022 ( P < 0.0001). Ratios of cases logged by residents in the 70th percentile to those in the 30th percentile decreased for vaginal hysterectomies and cystoscopies ( P < 0.0001 and P = 0.0040, respectively). The ratio for incontinence and pelvic floor procedures (excluding cystoscopies) was 1.76 in 2012/2013 and 2.35 in 2021/2022 ( P = 0.2878). CONCLUSION Resident surgical training in urogynecology is decreasing nationally.
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Affiliation(s)
| | | | | | - Shannon L Wallace
- Division of Urogynecology and Pelvic Floor Disorders, Women's Health Institute, Cleveland Clinic, Cleveland, OH
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Temkin SM, Terplan M. Levels of Gynecologic Care: A Task Force Consensus Statement. Obstet Gynecol 2023; 142:993-994. [PMID: 37734102 DOI: 10.1097/aog.0000000000005363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
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King LP. The Pay Gap in Gynecologic Surgery and Its Effects on Training Quality. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Louise P. King
- Brigham and Women's Hospital, Center for Bioethics Harvard Medical School, and Petrie Flom Center Harvard Law School
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Youssef Y, Afaneh H, Borahay MA. Strategies for Cost Optimization in Minimally Invasive Gynecologic Surgery. JSLS 2022; 26:JSLS.2022.00015. [PMID: 36071991 PMCID: PMC9385110 DOI: 10.4293/jsls.2022.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Cost and quality are important, complex, and intertwined surgical outcomes. Evidence suggests that major cost drivers include operating room time, length of stay, re-admission, surgical complications, and quality of pre-operative and operative care in general. Our practices shape both costs and quality of gynecologic surgery. Various factors are explored in this review article to present and identify ways to implement cost-effective change that also improve quality of patient care. Database: We searched MEDLINE and PubMed databases for relevant articles. Discussion: Clinical preferences and decisions, surgeon experience, trainee education, and defensive medicine can influence cost. In addition, an incongruent physician-administration relationship may impact decisions across the healthcare system. The accelerating adoption of minimally invasive surgery, particularly the robotic approach, presents both an opportunity and a challenge. An example of practices that improve outcomes, patient satisfaction, and cut cost is pre-operative optimization, enhanced recovery after surgery, and the growing adoption of outpatient hysterectomy. The identification of cost-drivers and finding strategies to improve them would simultaneously improve quality and patient outcomes while reducing costs in minimally invasive gynecologic surgery.
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Affiliation(s)
- Youssef Youssef
- Department of Obstetrics and Gynecology, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, MI
| | - Huda Afaneh
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD
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Very Low Rates of Ureteral Injury in Laparoscopic Hysterectomy Performed by Fellowship-Trained Minimally Invasive Gynecologic Surgeons. J Minim Invasive Gynecol 2022; 29:1099-1103. [PMID: 35691546 DOI: 10.1016/j.jmig.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE The objective of this case series is to evaluate the rates of ureteral injury at the time of laparoscopic hysterectomy among high-volume fellowship-trained surgeons. DESIGN A retrospective chart review was performed, evaluating laparoscopic hysterectomy cases between 2009-2019 performed exclusively by fellowship-trained surgeons. SETTING Division of Minimally Invasive Gynecologic Surgery (MIGS) at the Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital, a Harvard Medical School teaching hospital in Boston. PATIENTS All patients undergoing laparoscopic hysterectomy by one of five surgeons with fellowship training in Minimally Invasive Gynecologic Surgery (MIGS). INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: A total of 5,160 cases were performed by MIGS surgeons between 2009-2019 at our institution. Out of these cases, 2,345 were laparoscopic hysterectomy cases with available intraoperative and postoperative documentation. Most patients had prior surgeries and the most common indications for hysterectomy included uterine fibroids, pelvic pain/endometriosis, and abnormal uterine bleeding. At the time of hysterectomy, 1 ureteral injury (0.04%) was noted. No additional delayed ureteral injuries were observed. The majority of patients were discharged home the same day (64.9%) and did not have any postoperative complications (63.9%) as designated by the Clavien-Dindo classification. CONCLUSION Ureteral injury, while rare, is more prevalent in gynecologic surgery as compared to other surgical disciplines that have some focus in the pelvis. No study to date has evaluated the effect of surgical training and volume on rates of ureteral injuries. This study retrospectively examined ureteral injury rates for one group of high-volume fellowship-trained surgeons and found their rates to be lower than the national average. Proposals are presented for optimizing training and delivery of gynecologic surgical care to minimize complications.
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Roque DR, Hinchcliff E, Alter R, Barber EL, Marcus J, Tanner E. Surgical Training in Gynecologic Oncology:A Sea Change. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dario R. Roque
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Hinchcliff
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raanan Alter
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Emma L. Barber
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jenna Marcus
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Edward Tanner
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Kramer KJ, Rhoads-Baeza ME, Sadek S, Chao C, Bell C, Recanati MA. Trends and Evolution in Women's Health Workforce in the First Quarter of the 21 st Century. WORLD JOURNAL OF GYNECOLOGY & WOMENS HEALTH 2022; 5:622. [PMID: 35601601 PMCID: PMC9122235 DOI: 10.33552/wjgwh.2022.05.000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medicine in general, and particularly women's health, is rapidly evolving. This brief communication exposes some of the changes in Obstetrics and Gynecology but are relevant to all areas of medicine. As medical knowledge grows exponentially, there may be a greater sub-specialization of physicians, residency education must adapt, physician burnout remains an issue and clinician-scientists are becoming a dying breed. In addition, healthcare delivery systems and technological innovations, such as intelligent-EMRs, promise to support physician and prevent medical errors.
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Affiliation(s)
- Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Medical Centers Manhattan, New York, NY, 10011 USA
| | - M. Elena Rhoads-Baeza
- Department of Obstetrics and Gynecology, University of California at Irvine, Orange, CA, 92868 USA
| | - Sandra Sadek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center, Houston, TX, 77030 USA
| | - Conrad Chao
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, 87131 USA
| | - Capricia Bell
- Wayne State University School of Medicine, Detroit, MI, 48201 USA
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Wright KN, Truong M, Siedhoff MT. Residency Training in Gynecologic Surgery: Where Do We Go from Here? J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kelly N. Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mireille Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew T. Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Gender Equity in Gynecologic Surgery: Lessons from History, Strengthening the Future. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00307-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care. Obstet Gynecol 2021; 137:657-661. [PMID: 33706362 DOI: 10.1097/aog.0000000000004309] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
In this commentary, we describe historical and other influences that drive "double discrimination" in gynecologic surgery-lower pay in the area of surgery that boasts the largest proportion of female surgeons and is focused on female patients and explore how it results in potentially lower quality care. Insurers reimburse procedures for women at a lower rate than similar procedures for men, although there is no medically justifiable reason for this disparity. The wage gap created by lower reimbursement rates disproportionately affects female surgeons, who are disproportionately represented among gynecologic surgeons. This contributes to a large wage gap in surgery for women. Finally, poor reimbursement for gynecologic surgery pushes many obstetrics and gynecology surgeons to preferentially perform obstetric services, resulting in a high prevalence of low-volume gynecologic surgeons, a metric that is closely tied to higher complication rates. Creating equity in reimbursement for gynecologic surgery is one important and ethically required step forward to gender equity in medicine for patients and surgeons.
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