Use of Historic Surgical Times to Predict Duration of Hysterectomy: Stratifying by Uterine Weight.

STUDY OBJECTIVE: To describe the accuracy of historic averages for estimating operating room (OR) time for hysterectomy among women with small and large uteri. DESIGN: A retrospective cohort study. SETTING: Data from women who underwent abdominal, vaginal, or laparoscopic hysterectomy between 2015 and 2017 at the University of North Carolina Hospitals were analyzed. Historic and actual OR times were compared using linear regression. Patient characteristics were also evaluated to determine whether they were associated with the accuracy of predicted OR times. PATIENTS: Nine hundred eighty-five adult women (≥18 years old) who underwent surgery for benign indications or for suspected but not biopsy-confirmed malignancy were included. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Historic averages overestimated OR time by a median of 14 minutes (interquartile range [IQR] = -29 to 49 minutes). The OR time in women with small uteri (<250 g) was significantly more likely to be overestimated than women with large uteri (≥250 g) (median time = 21 minutes [IQR = -16 to 52 minutes] and 3 minutes [IQR = -38 to 44 minutes], respectively; p <. 001). In total laparoscopic hysterectomy and laparoscopy-assisted vaginal hysterectomy, women with uteri ≥250 g took significantly longer than hysterectomy for women with uteri <250 g (36 minutes longer [95% confidence interval, 24-50] and 95 minutes longer [95% confidence interval, 12-179], respectively; p < .001 and p = .03). CONCLUSION: Using historic averages overestimates OR time, and it is more pronounced in women with small uteri. However, there is a relatively large range of OR times, even among women with the same size uteri. This study highlights the importance of preoperative planning, and in cases in which endometriosis is expected, manually adding time to estimates is recommended.

Objective Structured Assessment of Technical Skills to Teach and Study Retention of Fourth-Degree Laceration Repair Skills.

BACKGROUND: Fourth-degree perineal lacerations are a serious but infrequent complication of childbirth. OBJECTIVE: We studied the long-term effect of an educational workshop on the knowledge and ability of obstetrics and gynecology residents to repair fourth-degree lacerations. METHODS: We assessed obstetrics and gynecology residents' baseline knowledge and skill of fourth-degree laceration repair by using a written examination and the Objective Structured Assessment of Technical Skills (OSATS). After the educational intervention (a lecture, a demonstrational video, and practice on a model), residents completed a written and OSATS posttest. Six months later, residents took the same posttests to determine their level of retention. Another group of residents who had not attended the workshop also took the tests at the 6-month mark and served as a control group. RESULTS: A total of 17 residents were in the intervention group and 11 residents in the control group. The pretest written examination mean was 6.1/10 and the OSATS mean was 10.9/18. After the workshop, the written mean increased to 9.1/10 and the OSATS to 16.6/18. This improvement was statistically significant (P < .01). Compared to the pretest, the 6-month follow-up scores had a statistically significant increase (written mean, 8.0/10, P < .01, and OSATS mean 15.5/18, P < .01). CONCLUSIONS: Residents improved on the written examination and OSATS after the educational workshop and maintained this improvement for 6 months. This intervention may prepare graduating residents for repairing future fourth-degree lacerations they may not have encountered during training.