Does surgeon seniority affect adhesion assessment at cesarean delivery? A prospective study.

BACKGROUND: Intraabdominal adhesions may develop following cesarean delivery and are considered a major concern. OBJECTIVE: This study aimed to determine the effect of surgeon seniority in evaluating intraabdominal adhesions at cesarean delivery. STUDY DESIGN: A prospective study to estimate interrater reliability between surgeons was conducted. Women who underwent cesarean delivery (January-July 2021) in a single tertiary university-affiliated medical center were included. Blinded questionnaires assessing adhesions were completed by the surgeons. Questions were limited to 4 main anatomic sites and 3 possible categories of adhesion (each site was scored between 0 and 2; the sum score range was 0-8). The surgeons were ranked by increasing seniority (1-4) as: (1) junior residents (less than half of residency completed), (2) senior residents (more than half of residency completed), (3) young attending physicians (attending physicians for <10 years), and (4) senior attendings (attending physicians for >10 years). The weighted percentage of agreement was calculated between the 2 surgeons assessing the same adhesions. Scoring differences between the 2 surgeons (senior vs less senior) were also calculated. RESULTS: A total of 96 pairs of surgeons were included in the study. The sum interrater reliability found in the weighted agreement tests between surgeons was 0.918 (confidence interval, 0.898-0.938). When scoring differences between surgeons (senior vs less senior) were calculated, nonsignificant difference was found (mean sum score difference of 0.09 with a standard deviation of 1.03 in favor of the more experienced surgeon). CONCLUSION: Surgeon seniority does not affect subjective scoring of adhesion reports.

Venous thromboembolism during pregnancy: Trends, incidence, and risk patterns in a large cohort population.

OBJECTIVE: To determine the incidence and risk factors for pregnancy-associated venous thromboembolism (VTE). METHODS: An observational retrospective study was conducted using data from 452 176 live births between the years 2010 and 2019. The study group consisted of women who were diagnosed with VTE during pregnancy or the postpartum period. The exclusion criteria included women who purchased anticoagulant drugs during pregnancy or postpartum. The hazard ratios (HRs) of VTE per week of each trimester and the postpartum period were calculated. RESULTS: A total of 421 125 live births were included in the study. Among the study population, 302 cases (0.71 cases/1000 pregnancies) were diagnosed with VTE during pregnancy and postpartum. The overall rates of diagnosis did not change significantly during the study period but followed a declining trend in the postpartum period. The highest risk of VTE was found to be during the third trimester (HR 0.002% per week, 95% confidence interval [CI] 0.0016-0.0023), while the lowest rate was during the postpartum period (HR 0.0007% per week, 95% CI 0.0004-0.0011). CONCLUSION: Pregnancy and the puerperium are well-established risk factors for VTE. The present study demonstrates a declining trend in the risk and incidence of VTE during the postpartum period, which can be explained by a liberal and effective VTE prevention policy.