"Best practices in risk reducing bilateral salpingo-oophorectomy: the influence of surgical specialty"

Background

Risk-reducing bilateral salpingo-oophorectomy (RRBSO) increases survival in patients at high risk of developing ovarian cancer. While many general gynecologists perform this procedure, some argue it should be performed exclusively by specialists. In this retrospective observational study, we identified how often optimal techniques were used and whether surgeons’ training impacted implementation.

Methods

We used the ACOG guidelines highlighting various aspects of the procedure to determine which elements were consistent with best practices to maximize surgical prophylaxis. All cases of RRBSO from 2006 to 2010 were identified. We abstracted data from the operative and pathology reports to review the techniques employed. Fisher’s exact test and chi-square were utilized to compare differences between groups (InStat, La Jolla, CA).

Results

Among 263 RRBSOs, 22 were performed by general gynecologists and 241 by gynecologic oncologists. Gynecologic oncologists were more likely to perform pelvic washings—217/241 vs. 10/22 (p < .0001). They were more likely to include a description of the upper abdomen—220/241 vs. 12/22 (p < .0001). Oncologists were more likely to utilize a retroperitoneal approach to skeletonize the infundibulopelvic ligaments—157/241 vs. 3/22 (p < .0001). When operations were performed by oncologists, the specimens were more often completely sectioned—217/241 vs. 16/22 (p = .003). The use of a retroperitoneal approach among gynecologic oncologists increased over the study period (chi-square for trend, p < .0001). There was no visible trend in performance improvement in any other area when looking at either group.

Conclusion

Gynecologic oncologists are more likely to adhere to best practice techniques when performing RRBSO, though there was room for improvement for both groups.

Trends in endemic of respiratory syncytial virus infection during COVID-19 pandemic and difficulty in obtaining optimal timing of palivizumab prophylaxis

OBJECTIVE

The coronavirus disease (COVID-19) pandemic has affected the epidemiology of respiratory syncytial virus (RSV) infection. This study assessed whether or not palivizumab prophylaxis was appropriate during the COVID-19 pandemic.

METHODS

This prospective study included children <24 months old who were hospitalized for RSV infection between April 2019 and March 2023. We compared the clinical characteristics of inpatients with RSV infection, with and without palivizumab prophylaxis.

RESULTS

During the investigation period, 2133 children <24 months old were hospitalized for RSV infection. The hospitalization rate of RSV infection in children receiving palivizumab prophylaxis (0.7 %) was significantly lower than that in children without the prophylaxis (3.1 %, P < 0.001), indicating that the timing of prophylaxis was roughly appropriate in preventing hospitalization for RSV infection. In contrast, palivizumab prophylaxis was performed during the non-endemic period of RSV infection due to changes in RSV infection endemics due to the impact of the COVID-19 pandemic.

CONCLUSION

Palivizumab is useful in preventing hospitalization for RSV infection in children with a high risk of developing severe respiratory tract infections. However, since the RSV infection endemics varies not only during the occurrence of an emerging infectious disease, such as COVID-19, but also from year to year, a system that can quickly recognized the endemics is needed to avoid the inappropriate use of palivizumab. Furthermore, it is also necessary to actively promote maternal RSV vaccination to prevent severe RSV infection in all infants and young children.