Perioperative Antibiotic Use and Associated Infectious Outcomes at the Time of Myomectomy.

OBJECTIVE: To report the frequency of perioperative antibiotic use at time of myomectomy and associated risk of infectious outcomes. METHODS: We conducted a retrospective cohort study including all women who underwent any route of myomectomy from 2009 to 2016 at two academic hospitals in Boston, Massachusetts. Cases involving chromopertubation or conversion to hysterectomy were excluded from further analysis. Medical records were queried for the use or nonuse of perioperative antibiotics, as well as baseline patient factors and perioperative outcomes. Statistical analyses included univariate comparisons between treatment groups, as well as multivariable logistic regression analyses of infectious morbidity controlling for patient age, route of surgery, presence of high-risk factors, any intraoperative complication, myoma weight, and entrance into the endometrial cavity. Matched cohort analysis also was performed to confirm findings in the setting of underlying differences between groups. RESULTS: A total of 1,211 patients were included in the myomectomy cohort, 92.7% of whom received perioperative antibiotics at the time of surgery. Demographic characteristics were similar between the group that received and the group that did not receive antibiotics. The cases with antibiotic use were associated with longer operative times, higher estimated blood loss, and greater myoma burden. No difference was noted with regard to intraoperative or postoperative complications. Surgical site infection occurred more commonly in the group that did not receive antibiotics (2.9% vs 6.8% in the antibiotic and no-antibiotic groups, respectively; effect size 0.43, 95% CI 0.18-0.97 P=.04), representing a nearly fourfold increase in odds of any surgical site infection in the absence of perioperative antibiotic use (adjusted odds ratio 3.77, 95% CI 1.30-10.97, P=.015). CONCLUSION: A high frequency of antibiotic use was noted at time of myomectomy, despite lack of clear evidence supporting the practice. Patients who received perioperative antibiotics had fewer postoperative infectious outcomes and, in particular, experienced a lower incidence of surgical site infection.

The Trend, Feasibility, and Safety of Salpingectomy as a form of Permanent Sterilization.

STUDY OBJECTIVE: To assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL). DESIGN: A retrospective cohort study. SETTING: Four university-affiliated hospitals in Houston, TX, and New York, NY. PATIENTS: All women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016. INTERVENTIONS: Sterilization by bilateral salpingectomy or conventional tubal ligation. MEASUREMENTS AND MAIN RESULTS: There were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001). CONCLUSIONS: The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists' support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.

Interpreter training for medical students: pilot implementation and assessment in a student-run clinic.

BACKGROUND: Trained medical interpreters are instrumental to patient satisfaction and quality of care. They are especially important in student-run clinics, where many patients have limited English proficiency. Because student-run clinics have ties to their medical schools, they have access to bilingual students who may volunteer to interpret, but are not necessarily formally trained. METHODS: To study the feasibility and efficacy of leveraging medical student volunteers to improve interpretation services, we performed a pilot study at the student-run clinic at the Icahn School of Medicine at Mount Sinai. In each fall semester in 2012-2015, we implemented a 6-h course providing didactic and interactive training on medical Spanish interpreting techniques and language skills to bilingual students. We then assessed the impact of the course on interpreter abilities. RESULTS: Participants' comfort levels, understanding of their roles, and understanding of terminology significantly increased after the course (p < 0.05), and these gains remained several months later (p < 0.05) and were repeated in an independent cohort. Patients and student clinicians also rated participants highly (averages above 4.5 out of 5) on these measures in real clinical encounters. CONCLUSIONS: These findings suggest that a formal interpreter training course tailored for medical students in the setting of a student-run clinic is feasible and effective. This program for training qualified student interpreters can serve as a model for other settings where medical students serve as interpreters.