Exploring Clinicians' Willingness to Embrace Customizable Pessaries: A Survey Study in the USA.

INTRODUCTION AND HYPOTHESIS: This study surveyed urogynecologists and Advanced Practice Providers (APPs) in the USA to gauge their interest and willingness to embrace customizable pessaries as a viable treatment option. We hypothesize that clinicians might be interested in using customizable pessaries in their practice. METHODS: A cross-sectional survey was conducted among urogynecologists and their APPs who fit pessaries to gain insights into their experiences with standard pessaries and perspectives on the value and feasibility of customizable devices. The survey was distributed through email lists associated with women's health and pelvic floor disorders and gathered data on the difficulty in fitting pessaries and the perceived advantages of integrating customizable options into clinical practice. RESULTS: There were 122 participants, including 76 physicians and 46 APPs. Thirty-five percent of clinicians advocated for pessaries as a first-line therapy for pelvic floor disorders. APPs were more inclined to recommend pessaries as a primary therapy than physicians (p < 0.01). Fifty-three percent of providers reported occasional difficulties, and 12% reported frequent difficulties fitting patients with standard-shaped pessaries. APPs were significantly more likely to encounter fitting issues due to pessary shape (p = 0.023). Clinicians suggested additional practices, such as modifying pessaries to enhance retention in patients with an enlarged genital hiatus, shortened vaginas, or apical narrowing. CONCLUSIONS: This study indicates that clinicians are inclined to incorporate customizable pessaries into their treatment protocols for pelvic floor disorders, emphasizing the need for continued innovation in pessary customization that prioritizes a patient-centric approach to pelvic floor disorder management.

Access to general obstetrics and gynecology care among Medicaid beneficiaries and the privately insured: a nationwide mystery caller study in the USA.

BACKGROUND: The mean wait time for new patient appointments has been growing across specialties, including obstetrics and gynecology, in recent years. This study aimed to assess the impact of insurance type (Medicaid versus commercial insurance) on new patient appointment wait times in general obstetrics and gynecology practices. METHODS: A cross-sectional study used covert mystery calls to general obstetrician gynecologists. Physicians were selected from the American College of Obstetricians and Gynecologists directory and stratified by districts to ensure nationwide representation. Wait times for new patient appointments were collected and analyzed. RESULTS: Regardless of insurance type, the mean wait time for all obstetrician gynecologists was 29.9 business days. Medicaid patients experienced a marginally longer wait time of 4.8% (Ratio: 1.048). While no statistically significant difference in wait times based on insurance type was observed (P=0.39), the data revealed other impactful factors. Younger physicians and those in university-based practices had longer wait times. The gender of the physician also influenced wait times, with female physicians having a mean wait time of 34.7 days compared to 22.7 days for male physicians (P=0.03). Additionally, geographical variations were noted, with physicians in American College of Obstetricians and Gynecologists District I (Atlantic Provinces, CT, ME, MA, NH, RI, VT) having the longest mean wait times and those in District III (DE, NJ, PA) the shortest. CONCLUSIONS: While the type of insurance did not significantly influence the wait times for general obstetrics and gynecology appointments, physician demographic and geographic factors did.

Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study.

IMPORTANCE: Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. OBJECTIVES: This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. STUDY DESIGN: A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. RESULTS: A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). CONCLUSION: The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.

Insurance Status and Access to Otolaryngology Care: National Mystery Caller Study in the United States.

OBJECTIVE: To investigate potential differences in new patient appointment wait times for otolaryngology care based on insurance types and explore factors influencing these wait times. STUDY DESIGN: A cross-sectional audit study, using a "mystery caller" approach, analyzed with a linear mixed Poisson model to adjust for confounding factors. SETTING: A total of 612 physicians across 49 states and the District of Columbia, representing 6 otolaryngology subspecialties, were included. METHODS: Otolaryngology physicians were contacted by mystery callers via telephone with scripted clinical vignettes as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance. Callers requested next available appointment. Wait times for new patient appointments were recorded and analyzed in R using a generalized linear mixed Poisson model. RESULTS: A total of 1183 of 1224 calls reached a representative. Medicaid patients waited 5.73% longer (P < .001) compared to BCBS patients (IRR: 1.06; confidence interval [CI]: 1.03-1.09; P < .001), with respective mean wait times of 36.8 days (SE ± 1.6) and 32.4 days (SE ± 1.6). Longer waiting times were also associated with physicians affiliated with universities (P = .001) and certain subspecialties, such as pediatric otolaryngology (P < .001) and neurotology (P = .008). Regional differences were also observed, with specific AAO-HNS regions showing shorter wait times. The model achieved a conditional R-squared value of 0.947. CONCLUSION: This study reveals disparities in wait times for otolaryngology care based on insurance type, with extended wait times for Medicaid beneficiaries. The findings highlight a potential access to care disparity, which begets the need for strategies that ensure equitable access to otolaryngology care and further research to understand the underlying reasons for these potential disparities.

The Financial Relationship Between the Medical Industry and Residency Leadership in OB/GYN and Urology.

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P<.01; $1,689,519.48 vs $4,352,066.40, P<.01). Department chairs received more payments per year than program directors (8 vs 4, P<.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P<.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

Subspecialty Faculty in Obstetrics and Gynecology: Distribution, Demographics, and Implications for Training and Clinical Practice.

OBJECTIVE: The objective of this study was to quantify the subspecialist workforce involved in the clinical education of Obstetrics and Gynecology (OBGYN) residents and to provide an overview of the subspecialist faculty workforce geographic distribution and demographics. METHODS: This cross-sectional, observational study used public data collected from July 1, 2022, through August 31, 2022. A list of Obstetrics and Gynecology residency programs, their sponsoring institutions/locations, and affiliated locations was compiled from the American Medical Association's Fellowship and Residency Electronic Interactive Database. Faculty subspecialists' names were collected by manually searching each program's website. Demographics were collected from the National Plan and Provider Enumeration System. Subspecialty faculty who had completed an Obstetrics and Gynecology residency, were fellowship trained, and/or had board certification in the subspecialty were included in the study. RESULTS: A total of 4,659 subspecialist faculty were identified from 278 residency programs, representing 81.5% of the total subspecialist workforce in Obstetrics and Gynecology (n=5,716). Of the subspecialists identified, 2,838 were faculty at sponsoring institutions, representing 49.7% of the entire subspecialist workforce; the remainder worked with residents at affiliate locations. Our results showed 59.9% of subspecialists were female and 40.1% were male; 97.0% were allopathic subspecialists. The largest proportion of subspecialists were in the age group of 40-49 years (36.6%). Subspecialists were present in 45 states, with the exception of Alaska, Idaho, Montana, North Dakota, South Dakota, and Wyoming. CONCLUSION: Most of the Obstetrics and Gynecology subspecialty workforce is involved in the clinical education of OBGYN residents, with half of the workforce on faculty at the residency program sponsor site. The subspecialty faculty workforce is primarily female, has an allopathic degree, is mid-career, and is geographically diverse.

Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis: Developed by the AUGS Payment Reform Committee.

OBJECTIVE: This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. METHODS: This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. RESULTS: Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). CONCLUSIONS: In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.

Medicaid coverage and access to obstetrics and gynecology subspecialists: findings from a national mystery caller study in the United States.

BACKGROUND: Previous research suggests that access to healthcare may influence the diagnosis and treatment of obstetrical and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no study has assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type (Medicaid vs commercial). OBJECTIVE: This study aimed to evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid vs commercial insurance. STUDY DESIGN: Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Of note, 800 unique physicians were randomly selected from the directories (200 per subspecialty). Of the 800 physicians, each physician was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility. RESULTS: From 800 physicians initially contacted, 477 responded to at least 1 call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 business days (standard deviation, ±18.6). A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio, 1.44; 95% confidence interval, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (P<.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time than commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid-insured patient wait times were still longer than commercial-insured patient wait times. CONCLUSION: Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.

Effect of the COVID-19 Pandemic on Otolaryngology Trainee Surgical Case Numbers: A Multi-institutional Review.

OBJECTIVE: To determine the effect of the initiation of COVID-19-related restrictions on the volume of surgical cases performed by otolaryngology trainees. STUDY DESIGN: Multi-institutional retrospective analysis of resident surgical case logs. SETTING: Accredited residency training programs in otolaryngology head and neck surgery. METHODS: Resident surgical case logs were combined from 6 residency training programs from different regions of the United States. Case volumes were compared between the calendar year before March 1, 2020, and the year afterward. Subgroup analyses were performed for the type of hospital (university, pediatric, veteran, county) and the key index cases by subspecialty. RESULTS: All 6 participating residency programs had a decrease in resident operative case volume. Surgical volume decreased from a mean of 6014 to 4161 (P < .05). There were decreases observed in key index cases in every subspecialty (P < .01), without statistical differences seen among subspecialties. There were decreases observed in every hospital type (university, pediatric, veteran, county) without statistical differences among types. Postgraduate year 5 residents were the most affected by volume reductions (51.6%), and postgraduate year 3 residents were the least affected (1.4%). CONCLUSION: In the year following initiation of COVID-19-related restrictions, there was a significant decrease in trainee surgical case volumes within residencies for otolaryngology-head and neck surgery. There were no statistical differences in the volume decreases seen at different institutions, among hospital types, or within various subspecialties.

American Indian and Alaskan Native Access to Obstetrics and Gynecology Subspecialists: Findings From a National Mystery Caller Study in the United States.

Background A significant disparity exists for American Indian and Alaska Native populations in accessing obstetric and gynecology (OBGYN) subspecialty care, as nearly 43% of individuals do not reside in areas where the Indian Health Service (IHS) provides care. Geographical separation from IHS facilities exacerbates healthcare disparities, particularly regarding access to specialized services. This study aims to create a map illustrating the average driving time from an IHS clinic to OBGYN subspecialists (e.g., gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility [REI]) and determine the average wait time for appointments with these specialists. Study design A cross-sectional and mystery caller study was conducted using hospital-level data from the IHS and data on women from the 2010 United States Census provided by the US Census Bureau. All US OBGYN subspecialists were identified and mapped. The local distribution of clinics near IHS hospitals was determined, and the nearest OBGYN subspecialist was mapped to IHS hospitals providing women's care services. Thirty-seven OBGYN subspecialists closest to IHS hospitals were contacted to calculate the mean wait time for subspecialty care appointments. Results The median driving time to the closest gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility OBGYN subspecialist was 214 minutes (interquartile range [IQR] 107-290). The longest drive to see a subspecialist for urogynecology services was over 240 minutes. From the 2010 US Census, we identified 583,574 American Indian and Alaska Native (AI/AN) pediatric, adolescent, and women within a 60-minute drive of an IHS hospital. The mean wait time for a new patient appointment was 13.6 business days (SD ± 2). Conclusions Geographical disparities significantly impact the ability of American Indian and Alaska Native populations to access OBGYN subspecialty care. There was no difference in wait times compared to the national average, though there were significantly longer drive times.

Medicare Patient Referral Networks to Pelvic Floor Physical Therapy Across the United States.

OBJECTIVE: The purpose of this study is to evaluate the distribution of referrals to pelvic floor physical therapy throughout the United States and to identify specialties with the highest and lowest referral rates. Referral networks to pelvic floor physical therapy were identified, and factors associated with referral connections were determined. METHODS: This retrospective network analysis of referrals examined U.S. Centers for Medicare and Medicaid Services data from 2009 to 2017. Pelvic floor physical therapists were identified, and their patient-sharing networks were modeled using social network analytics. RESULTS: There were 18,740 Medicare beneficiaries referred to pelvic floor physical therapists between 2009 and 2017. The mean number of referrals to each physical therapy provider or practice was 82 (SD ±46.3). Half of the referrals were made by a general acute care hospital. The remainder were referred by female pelvic medicine and reconstructive surgeons, nurse practitioners, colorectal surgeons, internal medicine, and obstetrician-gynecologists.The number of individual pelvic floor physical therapists, as well as the referrals, increased each year. The geographic representation of the patient referral networks is illustrated. The map reveals that pelvic floor physical therapists often work in groups and treat patients in their geographic vicinity. In this study, we demonstrate intensely fractured referral networks. CONCLUSION: Our network analysis of pelvic floor physical therapy referrals in Medicare patients across the United States shows fractured networks with dense geographic connections in some areas, whereas sparse in others. Multidisciplinary approaches and early referrals to pelvic floor physical therapy are recommended as some ways to amend these fractured networks.

Appointment Wait Times in Female Pelvic Medicine and Reconstructive Surgery: A Mystery Caller Study.

OBJECTIVE: The aim of the study was to evaluate the mean appointment wait time for a new patient visit at outpatient female pelvic medicine and reconstructive surgery (FPMRS) offices for U.S. women with the common and nonemergent concern of uterine prolapse. METHODS: The American Urogynecologic Society "Find a Provider" tool was used to generate a list of FPMRS offices across the United States. Each of the 427 unique listed offices was called. The caller asked for the soonest appointment available for her mother, in whom uterine prolapse was recently diagnosed. Data for each office were collected, including date of the earliest appointment, FPMRS physician demographics, and office demographics. Mean appointment wait time was calculated. RESULTS: Four hundred twenty-seven FPMRS offices were called in 46 states plus the District of Columbia. The mean appointment wait time was 23.1 business days for an appointment (standard deviation, 19 business days). The appointment wait time was 6 days longer when seeing a female FPMRS physician compared with a male FPMRS physician (mean, 26 business days vs 20 business days, P < 0.02). There was no difference in wait time by day of the week called. CONCLUSIONS: Wait times are a measure of access to care within the health care system. Shorter wait times are associated with increased patient satisfaction. Typically, a woman with uterine prolapse can expect to wait at least 4 weeks for a new patient appointment with an FPMRS board-certified physician listed on the American Urogynecologic Society website. The first available appointment is more often with a male physician. A patient can expect to wait 6 days longer to see a female FPMRS physician. As mean wait times across outpatient specialties continue to increase, FPMRS offices should strive to keep wait times at a minimum to allow women timely access to care.

Hysterectomy Volume Among Recent Obstetrics and Gynecology Residency Graduates.

OBJECTIVE: Although guidelines recommend hysterectomy be performed vaginally whenever possible, recent trainees have decreased exposure to vaginal hysterectomy given the availability of laparoscopic hysterectomy, nonsurgical management, and falling volume nationwide. We sought to estimate hysterectomy volume in the 5 years after residency. Our secondary objective was to compare vaginal hysterectomy utilization between recent graduates and senior surgeons. METHODS: Retrospective, statewide data from 2005 to 2014 was obtained from the Massachusetts Center for Health Information Analysis. All hysterectomies performed in Massachusetts, regardless of payer type, were included. Surgeon identifiers were cross-referenced to another data set with provider demographics. Hysterectomies performed in the first 5 years after graduation were compared with a group 21 to 25 years after residency. RESULTS: Data from inpatient and outpatient databases revealed 87,846 hysterectomies performed by 1967 physicians, including 3146 simple hysterectomies by 192 recent graduates. Recent graduates chose abdominal hysterectomy (44.2%) most commonly, followed by laparoscopic (29.4%), vaginal (16.1%), and laparoscopically assisted vaginal (10.4%). Recent graduates performed a median of 3 to 4 hysterectomies in each of the first 5 years with no increase over time (P = 1). The median number of vaginal or laparoscopic hysterectomies was 0 in these 5 years (interquartile ranges, 0-1 and 0-2, respectively). Members of the senior cohort performed a median of 8 to 9 hysterectomies annually, completing them vaginally more often (24.7% vs 16.1%, P < 0.01). When controlling for patient age and hysterectomy indication, this effect dissipated. CONCLUSIONS: Recent graduates perform 3 to 4 (interquartile range, 1-7) hysterectomies annually, predominantly by laparotomy. Although senior surgeons perform vaginal hysterectomy more often, this is explained by patient characteristics.

Medicare Patient Referral Networks to Female Pelvic Medicine and Reconstructive Surgeons Across the United States.

OBJECTIVE: The source of urogynecology patient referrals remains poorly understood. We used novel methods to identify referral networks to female pelvic medicine and reconstructive surgeons (FPMRS) and to determine factors associated with physician connections. METHODS: A retrospective analysis of Centers for Medicare and Medicaid Services data with physician sharing relationships spanning 180 days during 2015 was performed. All patients studied were Medicare beneficiaries. Provider patient-sharing networks were modeled using social network analytics. To visualize the resulting flow of patients from referring providers to FPMRS, we encoded the node and edge data and mapped the data to a map of the United States. RESULTS: We studied 206,568 Medicare beneficiaries who were seen by 618 different board-certified FPMRS. Internal medicine physicians followed by nurse practitioners referred the most patients to FPMRS. Over half of referrals were made locally, with patients traveling less than 5 miles from the referring provider to the female pelvic surgeon. The median number of incoming Medicare patient referrals per FPMRS provider was 15 (interquartile range, 12-20) over a 6-month period. The high modularity of the referral network indicates that most providers refer their patients to a few female pelvic surgeons. CONCLUSIONS: Medicare patient referrals to FPMRS are primarily and proportionally the highest from local internal medicine physicians.

Practice Characteristics of Board-certified Pediatric Anesthesiologists in the US: A Nationwide Survey.

Introduction We conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination. Methods In July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards. Results There were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a pediatric anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children's hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice. Conclusion The extent to which pediatric anesthesiologists care for pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors.

Postoperative infections in women undergoing hysterectomy for benign indications: a cohort study.

BACKGROUND: There is limited data on the incidence of postoperative infections following hysterectomy by route of surgery. We hypothesize that vaginal hysterectomy has lower rates of postoperative infection than laparoscopic and abdominal hysterectomies. METHODS: A retrospective cohort study and independent hand review of charts of participants undergoing hysterectomy at five hospitals from September 2011 through May 2015 was performed. Cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and were reviewed by the investigators. The primary outcome was the development of Clostridium difficile infection, urinary tract infection, surgical site infection, or yeast vaginitis within 60 days following surgery. RESULTS: In total, 2742 women underwent hysterectomy: abdominal 17.5% (AH), laparoscopic 65.8% (LH), and vaginal 16.7% (VH). The composite postoperative infection rate for the four specified variables was 8.5% (232). In comparing surgical route, AH was most commonly associated with CDI (0.6%, p <0.001), SSI (6.0%, P=0.001), and yeast vaginitis (1.9%, p <0.001), while VH was most commonly associated with UTI (8.1%, P=0.002). After controlling for demographic and operative factors, multivariable analysis showed that hysterectomy route was not associated with infection. Independent predictors for postoperative infection were increasing age, American Society of Anesthesiologists physical status classification, operative time, and hospital type. CONCLUSIONS: Infectious complications after hysterectomy are uncommon, accounting for 8.5% of cases. Multivariable analysis showed that demographic and operative variables were more likely to serve as independent predictors of development of infection than hysterectomy route.

Brief versus Thong Hygiene in Obstetrics and Gynecology (B-THONG): A survey study.

AIM: The aim of this study was to evaluate if thong use is associated with a higher report of urogenital infections, including urinary tract infections, yeast vaginitis and bacterial vaginosis. METHODS: A cross-sectional survey regarding underwear preferences and infectious history was designed and distributed to women via a crowdsourcing service. All survey questions related to the last 12 months. Parametric and nonparametric statistical methods were used to compare responses between thong wearers and nonthong wearers. Thong wearers were defined as women who wore a thong equal to or more than 50 % of the time. RESULTS: Nine hundred and eighty-six respondents met inclusion criteria and completed the survey; 186 (18.9%) were defined as thong wearers and 800 (81.1%) were defined as nonthong wearers in the last 12 months. Reported rates of urogenital infections in the last 12 months were not significantly different for thong wearers versus nonthong wearers. Thong use was not an independent predictor of any urogenital infection in this study. CONCLUSION: In this large cross-sectional study we found that oral sex was the only independent predictor of urinary tract infection and bacterial vaginosis, and that wearing noncotton crotch underwear was associated with yeast vaginitis. Wearing thong underwear was not associated with any urogenital infections. Medical providers should discuss sexual practices and underwear fabric, rather than style, with their patients when there is concern for urogenital infection.

A 3-Dimensional Anatomical Education Model in Postpartum Perineal Laceration Care: A Pre-Post Intervention Study.

OBJECTIVE: The aim of this study was to investigate the effects of postpartum patients introduction to and interaction with a virtual 3-dimensional (3D) pelvic model on the self-care, knowledge, and anxiety parameters. METHODS: The model was designed from computed tomography data displaying the involvement of the levator ani in a fourth-degree perineal laceration. This 3D model was used to educate postpartum day 1 patients at the bedside. Patient data were collected using a pre and post questionnaire assessing knowledge, anxiety, and confidence in perineal wound self-care. RESULTS: Thirty-six patients were enrolled with a median age of 28.5 years (interquartile range, 31, 21.75 years) and a median parity of 1 (interquartile range, 2, 1). Patient use of the tool significantly decreased patient anxiety regarding perineal lacerations (P < 0.01) and significantly increased patient knowledge on what part of their vagina was lacerated during vaginal delivery (P < 0.01). CONCLUSIONS: Reviewing a 3D model of perineal lacerations with patients on postpartum day 1 is associated with less anxiety and increased knowledge of pelvic floor anatomy. These pilot data represent a preliminary investigation into the relations between 3D model of perineal lacerations and a range of patient outcomes.

Fellow Perceptions of Residency Training in Obstetrics and Gynecology.

OBJECTIVE: To evaluate the perceptions of current and former fellows in obstetrics and gynecology (OBG) subspecialties of their readiness for fellowship training. METHODS: A previously used survey was modified and distributed in 2016 to current and former fellows in gynecologic oncology, maternal-fetal medicine, reproductive endocrinology-infertility, and female pelvic medicine and reconstructive surgery. The survey explored domains of professionalism, independent practice, psychomotor ability, clinical evaluation, and scholarship. A standard Likert scale was employed and domains/responses were tailored to each subspecialty. Standard statistical models were utilized. RESULTS: A total of 478 fellows responded to the survey. Nearly 75% of fellows from each specialty reported feeling prepared or very prepared for fellowship. More than 65% of fellows from each specialty reported feeling very prepared to perform core surgical procedures. More than 90% of respondents reported having opportunities during residency to independently develop a plan of action for patients on labor and delivery. Fewer respondents reported opportunities to independently manage postoperative complications-40.7% of gynecologic oncology and 44.7% of female pelvic medicine and reconstructive surgery reported having such opportunities, whereas 91.9% of maternal-fetal medicine respondents reported having had such opportunities. While 46.4% of respondents received education on scientific writing during residency, 80% reported writing a manuscript as a resident. CONCLUSIONS: The majority of current and former fellows in OBG subspecialties report feeling prepared for fellowship in terms of clinical and surgical skills. Their feedback reveals opportunities for improvement of independent practice in gynecologic scenarios, as well as formal education on scientific research, for OBG residencies.