Surgical Outcomes for Transgender Men Undergoing Hysterectomy.

OBJECTIVE: This study sought to assess surgical outcomes of hysterectomy performed for transgender individuals compared with hysterectomy for individuals with menstrual disorders. METHODS: This retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Data of transgender individuals who underwent hysterectomy and individuals who underwent hysterectomy for menstrual disorders were extracted from the participant use data file (2015-2016). Transgender individuals were compared with individuals with menstrual disorders for surgical outcomes within 30 days of hysterectomy, by using appropriate statistical tests. A two-sided P value of less than 0.05 was considered statistically significant (Canadian Task Force Classification II-2). RESULTS: The study identified 89 cases of hysterectomy for transgender individuals and 4439 cases of hysterectomy for menstrual disorders. Compared with patients who underwent hysterectomy for menstrual disorders, transgender patients were more likely to be younger (mean ± SD 30.79 ± 9.68 years vs. 42.6 ± 7.04 years), have a normal body mass index (25.84% vs. 17.77%), be classified as American Society of Anesthesiologists class I (34.09% vs. 10.46%), and have outpatient surgery (76.40% vs. 53.55%) (P < 0.05). Overall incidence of postoperative complications was low for both groups. No significant difference in surgical outcomes was observed for re-admission, superficial or deep/organ space infections, wound dehiscence, sepsis, blood transfusion, deep vein thrombosis, pulmonary embolism, or death. Transgender patients who underwent hysterectomy on average required decreased operative time (120.4 ± 79.2 minutes vs. 131.2 ± 64.3 minutes) and decreased lengths of stay (0.82 ± 0.82 days vs. 1.35 ± 2.73 days). CONCLUSION: This study suggests that transgender patients undergoing hysterectomy were younger and healthier than patients undergoing hysterectomy for menstrual disorders. Surgical complications were low for both groups, and significant differences in surgical outcomes were not observed.

Hypoglycemia Incidence in Older Adults by Estimated GFR.

BACKGROUND: Bedside estimates of the risk for hypoglycemia by estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (ACR), and use of antihyperglycemic medications would be helpful. STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: Older adults (mean age, 75 years) in Ontario, Canada, from April 2002 through March 2013. FACTORS: eGFR stage, ACR stage, and use of antihyperglycemic medications. OUTCOME: 3-year incidence rate of a hospital encounter with hypoglycemia (emergency department or inpatient encounter). RESULTS: In users and nonusers of antihyperglycemic medications, there was a graded increase in risk for hypoglycemia by eGFR stage. Incidence rates in antihyperglycemic medication users were 82 (95% CI, 71-94), 122 (95% CI, 115-130), 235 (95% CI, 218-254), 379 (95% CI, 349-413), 596 (95% CI, 524-678), and 785 (95% CI, 689-894) encounters per 10,000 person-years when eGFR was ≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, and <15mL/min/1.73m2 or the patient was receiving dialysis, respectively (P<0.001). Corresponding values in nonusers were 2 (95% CI, 2-4), 3 (95% CI, 3-4), 3 (95% CI, 2-4), 7 (95% CI, 5-9), 14 (95% CI, 9-22), and 55 (95% CI, 43-71) encounters/10,000 person-years, respectively (P<0.001). A similar relationship was evident by eGFR and ACR risk category. LIMITATIONS: Only hypoglycemia episodes that were associated with a hospital encounter were assessed. Results cannot be generalized to younger patients. CONCLUSIONS: In older adults, the risk for hypoglycemia is higher in those with lower kidney function. Our results may aid the patient-provider dialogue and inform future studies to prevent hypoglycemia in an at-risk population.

Dienogest Therapy as a Treatment for Catamenial Pneumothorax: Case Report and Review of Hormonal Options.

BACKGROUND: Catamenial pneumothorax is a rare but serious condition for women of reproductive age. We describe a trial of dienogest as hormonal therapy for catamenial pneumothorax and review the literature on hormonal suppressive therapy for this condition. CASE: A 39-year-old female, gravida 0 para 0, presented with recurrent pneumothoraces coinciding with her menses. After surgical therapy, she was started on leuprolide acetate injections for 6 months to reduce recurrence. To reduce long-term side effects of leuprolide acetate, the patient was started on dienogest 4 mg orally once daily instead of leuprolide acetate for hormonal suppression and experienced resolution of recurrent pneumothoraces. CONCLUSION: For women with recurrent catamenial pneumothorax, dienogest may be an effective hormonal treatment option and alternative to long-term GnRH agonist therapy for long-term suppression.

Neighborhood Income and Cesarean Section Rates at a Tertiary Care Center in Canada.

Background: With rising rates of cesarean sections (CSs) in Canada and worldwide, nonclinical factors for CS warrant consideration. Objective: To determine the association between a primigravid woman's neighborhood income and rates of CSs. Materials and Methods: A retrospective cohort study was conducted at an Ontario tertiary care center from January 2003 to December 2013. Rates of CSs were determined using data collected from the Discharge Abstract Database. Women with singleton live births were included. The main exposure variable was the neighborhood income quintile. A multivariable model was used to adjust for covariates and provide an estimate of the independent effect of neighborhood income on the CS rate. Results: The study cohort comprised 32,714 women. Compared with the lowest quintile, women in the highest quintile had increased rates of CSs (relative risk, RR 1.06, 95% confidence interval, CI [1.02-1.11]). Following adjustment for important confounders, there was no longer an association between the neighborhood income and CS rate (adjusted RR 1.00, 95% CI [0.99-1.01]). Women in the highest quintile were more likely to have greater maternal age (p < 0.01). Conclusions: Although differences in CS rates are seen by the neighborhood income quintile, they appear to be mediated through a combination of maternal age and other clinical factors. Neighborhood income does not appear to be an independent predictor of CS.

Validation of an International Statistical Classification of Diseases and Related Health Problems 10th Revision Coding Algorithm for Hospital Encounters with Hypoglycemia.

OBJECTIVES: To determine the positive predictive value and sensitivity of an International Statistical Classification of Diseases and Related Health Problems, 10th Revision, coding algorithm for hospital encounters concerning hypoglycemia. METHODS: We carried out 2 retrospective studies in Ontario, Canada. We examined medical records from 2002 through 2014, in which older adults (mean age, 76) were assigned at least 1 code for hypoglycemia (E15, E160, E161, E162, E1063, E1163, E1363, E1463). The positive predictive value of the algorithm was calculated using a gold-standard definition (blood glucose value <4 mmol/L or physician diagnosis of hypoglycemia). To determine the algorithm's sensitivity, we used linked healthcare databases to identify older adults (mean age, 77) with laboratory plasma glucose values <4 mmol/L during a hospital encounter that took place between 2003 and 2011. We assessed how frequently a code for hypoglycemia was present. We also examined the algorithm's performance in differing clinical settings (e.g. inpatient vs. emergency department, by hypoglycemia severity). RESULTS: The positive predictive value of the algorithm was 94.0% (95% confidence interval 89.3% to 97.0%), and its sensitivity was 12.7% (95% confidence interval 11.9% to 13.5%). It performed better in the emergency department and in cases of more severe hypoglycemia (plasma glucose values <3.5 mmol/L compared with ≥3.5 mmol/L). CONCLUSIONS: Our hypoglycemia algorithm has a high positive predictive value but is limited in sensitivity. Although we can be confident that older adults who are assigned 1 of these codes truly had a hypoglycemia event, many episodes will not be captured by studies using administrative databases.