Clean-Catch Urine Specimen More Likely to Be Contaminated After Vaginal Surgery for Pelvic Organ Prolapse.

IMPORTANCE: Accurate diagnosis of urinary tract infection after pelvic organ prolapse (POP) surgery is essential to postoperative care. OBJECTIVE: Our aim was to determine the agreement between the urinalysis of a clean-catch versus a straight catheter urine specimen in women who underwent vaginal surgery for POP. STUDY DESIGN: This was a cross-sectional study evaluating patients after vaginal surgery for POP. A clean-catch and straight catheter urine specimen were collected at routine postoperative appointments. Routine urinalyses and urine cultures were performed for all patients. A urine culture yielding mixed urogenital flora (which includes Lactobacillus species), coagulase-negative staphylococci, and Streptococcus species was considered a contaminated result. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter at 3 weeks postoperatively was evaluated using weighted κ statistic. RESULTS: Fifty-nine participants enrolled. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter was poor (κ = 0.018). The urine culture was more likely to be contaminated from the clean-catch urine specimen than from the straight catheter urine specimen (53.7% vs 23.1%).The positive and negative predictive values of leukocyte esterase on clean catch were 22.6% and 100%, respectively. CONCLUSIONS: Diagnosing urinary tract infection based on contaminated urinalyses may lead to antibiotic overuse and misdiagnosis of postoperative complications. Our results can help educate health care partners and discourage the use of clean-catch urine specimens when assessing women who have recently undergone vaginal surgery.

Patient-Initiated Telephone Calls Before and After Introduction of an Enhanced Recovery After Surgery Protocol for Female Pelvic Reconstructive Surgery.

IMPORTANCE: An evaluation of Enhanced Recovery After Surgery (ERAS) effect on perioperative patient phone calls. OBJECTIVE: The aim of this study was to compare perioperative patient phone calls before and after implementation of ERAS. STUDY DESIGN: This is a retrospective chart review of women who underwent surgery by urogynecologists where ERAS was implemented. Patients who underwent surgery were identified before the implementation and compared with the same time period after implementation. Perioperative phone calls were reviewed and categorized by reason for call. Differences between the 2 groups were compared with a Student t test if normally distributed or with a Mann-Whitney U test if not. Categorical outcomes were reported with a percentage and compared with a χ2 test with an α level of 0.05. RESULTS: We reviewed 387 records. There was no difference in the percentage of patient calls before and after implementation of ERAS (preoperatively: 19.8% vs 25.1% [ P = 0.21], postoperatively: 64.1% vs 61.5% [ P = 0.61]). Questions about chronic home medications were the most common reasons for calling before surgery (pre-ERAS: 16 [42.1%]; post-ERAS: 12 [28.6%]). Questions related to medications, pain, and bowels were the top reasons people called postoperatively. These remained the top 3 in the post-ERAS time period; however, bowel-related questions switched with medications for the top reason. CONCLUSIONS: Despite patient education being an essential component of ERAS with written and verbal instructions provided, our study found no difference in preoperative or postoperative calls with the implementation. By focusing on common concerns, we may be able to improve the patients experience and reduce office phone calls.

Postoperative Utilization of Opioids After Midurethral Sling Surgery: A Prospective Clinical Practice Study.

IMPORTANCE: This study was performed to understand opioid consumption after midurethral sling (MUS) procedures to provide surgeons with guidelines on appropriate prescription regimens. OBJECTIVE: This study aimed to evaluate postdischarge narcotic use (PDNU) after MUS surgery using a restrictive postdischarge opioid regimen. STUDY DESIGN: This prospective clinical practice study included women undergoing MUS surgery from December 2018 to October 2019. Patients were discharged with an electronic prescription for 5 tablets of an oral narcotic. Brief Pain Inventory (BPI) surveys were collected preoperatively. Patients answered questions regarding remaining number of opioid tablets, BPI scores, and patient satisfaction on day 1, week 1 (postoperative week [POW] 1), and 4-6 weeks (POW4-6) postoperatively. Electronic records were reviewed to determine narcotic refills. Primary outcome was PDNU measured in morphine milligram equivalents (MME). Secondary outcomes evaluated refill rate, BPI scores, and patient satisfaction. Standard statistical tests were applied. RESULTS: Fifty-six patients were included in the analysis. Total median (interquartile range) PDNU was 12.5 (0-37.5) MME at POW1 and 15.0 (0-37.5) MME at POW4-6, which is approximately equivalent to 2 oxycodone (5 mg) tablets. Eighteen patients (32.1%) took 0 narcotics postdischarge. Brief Pain Inventory scores showed that "worst pain" was highest on postoperative day 1 with a median (interquartile range) score of 6 (4-8). At the POW1 and POW4-6 mark, 94.3% and 92% of patients, respectively, were satisfied or extremely satisfied with their pain control. Seven patients (11.8%) required a refill. CONCLUSIONS: Most patients undergoing MUS surgery used no more than 2 oxycodone (5 mg) tablets during their 6-week postoperative course, with almost a third not requiring any narcotics. Low pain scores and high patient satisfaction rates were noted.

Development and Validation of a Vaginal Anterior Repair Simulation Model for Surgical Training.

OBJECTIVE: The aims of this study were to design and to validate a surgical simulation model for vaginal anterior colporrhaphy. METHODS: Obstetrics and gynecology residents were divided into two groups: "novice" and "advanced." "Expert" group comprised female pelvic medicine and reconstructive surgery (FPMRS) fellows and faculty. All subjects were recorded performing anterior colporrhaphy using the simulation model. Deidentified, silent videos of recorded performances were evaluated by a blinded reviewer using the Objective Structured Assessment of Technical Skills (OSATS) and a procedure-specific assessment, based on the American Board of Obstetrics and Gynecology milestone evaluation. Analysis of variance was used for statistical comparisons. RESULTS: Thirty-seven participants included 13 novices, 18 advanced residents, and six experts. The experts scored significantly higher than both resident groups in each of the domains of the OSATS and the procedure assessment. The mean OSATS score for experts was 32.30 (±6.06) (maximum, 35); novice, 17.15 (±5.84); and advanced, 21.11 (±5.61) (P = 0.001). The experts' scores for the procedure assessment (maximum, 25) was 23.00 (±3.95); novice, 10.62 (±4.70); and advanced, 14.33 (±4.73) (P < 0.001). The two trainee groups did not differ significantly in their overall performance. Most trainees (29 [94%]) evaluated the model as a useful tool in learning this procedure. CONCLUSIONS: This low-fidelity model can be constructed easily using common materials. The model cost is $43.92 with reusable components ($11 per use). Higher scores by experts versus trainees confirm construct validity of this model. It may serve as a valuable simulation tool allowing trainees to improve their surgical technique for anterior colporrhaphy.

An Exploratory Analysis of Public Awareness and Perception of Ionizing Radiation and Guide to Public Health Practice in Vermont.

Exposure to ionizing radiation has potential for acute and chronic health effects. Within the general public of the United States, there may be a discrepancy between perceived and actual health risks. In conjunction with the Vermont Department of Health, a survey designed to assess public perception and knowledge of ionizing radiation was administered at 6 Vermont locations (n = 169). Descriptive and inferential statistical analyses were conducted. Eighty percent of respondents underestimated the contribution of medical imaging tests to total ionizing radiation exposure. Although only thirty-nine percent of participants were confident in their healthcare professional's knowledge of ionizing radiation, most would prefer to receive information from their healthcare professional. Only one-third of individuals who received a medical imaging test in the past year were educated by their healthcare professional about the risks of these tests. Those who tested their home for radon were twice as likely to choose radon as the greatest ionizing radiation risk to self. Although respondents had an above-average education level, there were many misperceptions of actual risks of exposure to ionizing radiation, particularly of medical imaging tests. Educating healthcare professionals would therefore have a profound and positive impact on public understanding of ionizing radiation.