Socioeconomic factors influence surgical wait times for non-emergent gynecologic surgical procedures: a retrospective analysis.

BACKGROUND: In various disciplines, an association between surgical wait times and patient outcomes has been identified. This study is among the first to investigate whether practice setting influences wait times for elective surgeries in benign gynecology. METHODS: This retrospective study of patients at three New York hospitals from 10/2019-2/2020 compared surgical wait times among patients seen in federally-qualified health centers (FQHC's) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of the procedure. A multivariable mixed model was used to model surgical wait time by setting of care, adjusting for age, BMI, race, ethnicity, insurance, need for medical clearance, and scheduled block time. A univariable analysis was then utilized to assess surgical wait times by clinical setting for each insurance type. RESULTS: Five hundred forty patients were identified with a median age of 45.6 years (range 16-87). Average surgical wait time was 27 days (range 1-288 days). In multivariable analysis, longer surgical wait times were associated with being seen preoperatively in a FQHC compared to the private practice setting (102% longer, 59.5 days vs. 22 days, p < 0.0001), and with needing medical clearance (56.4% longer, 45 days vs. 22 days. p = 0.0001). CONCLUSIONS: These results suggest that in benign gynecology, surgical wait times are significantly influenced by the practice setting in which a patient gets care, with notable delays in care among patients who are seen in a federally qualified health center preoperatively.

Virtual Interviews Improve Equity and Wellbeing: Results of a Survey of Applicants to Obstetrics and Gynecology Subspecialty Fellowships.

BACKGROUND: Nationwide restrictions and recommendations from the Association of American Medical Colleges mandated program directors to conduct all graduate medical education interviews virtually in the Spring of 2020 in response to the COVID-19 pandemic. This study was conducted to assess the impact of virtual interviews on a candidates' ability to effectively create a rank list. OBJECTIVE: The primary objective of this study was to evaluate Obstetrics and Gynecology (ObGyn) subspecialty fellowship applicants' perspectives regarding the effectiveness of virtual interviews for creating a rank list. Secondary outcomes included perceived advantages and disadvantages of the process and costs of the process. METHODS: This was a cross-sectional IRB-exempt study, using an electronic survey administered to a convenience sample of applicants to ObGyn subspecialty fellowship programs. The survey was administered via RedCap between the rank list submission deadline and the Match. Descriptive statistics were used. RESULTS: Response rate was 158/330 (48%). Overall, 129/158 (82%) percent of respondents felt confident in making their rank list based on the virtual interviews, and 146/158 (92%) were "very satisfied" or "somewhat satisfied" with the process. Of those who expressed an interview style preference, 65/149(44%) of respondents preferred virtual interviews; 49/149(33%) had no preference or were not sure. Nearly all 146/148(99%) applicants cited cost-savings as a distinct advantage of virtual interviews. CONCLUSION: Applicants to ObGyn subspecialty fellowships felt comfortable to create a rank list based on the virtual interview. This study indicates that the virtual format is effective, less stressful and less costly for ObGyn subspecialty interviews and should be considered beyond the pandemic to remove barriers and burdens for applicants.

Gender Equity in Academic Female Pelvic Medicine and Reconstructive Surgery Departments: A Cross-Sectional Observational Study.

IMPORTANCE: Gender equity in obstetrics and gynecology remains a barrier to career mobility and workplace satisfaction. OBJECTIVE: This study aimed to evaluate gender equity for academic positions in female pelvic medicine and reconstructive surgery (FPMRS) divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship in the United States. STUDY DESIGN: This was a cross-sectional observational study of all FPMRS divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship program in the United States in July 2020 using publicly available demographic and academic data collected from online search engines. Gender equity in academic FPMRS was assessed by gender representation, academic appointment, and research productivity of each attending physician within the division. Research productivity was assessed using both the H-index with career length controlled for with the M-quotient. RESULTS: There were 348 attending physicians from 72 FPMRS divisions (198 female [56.9%], 150 male [43.1%]). A large percentage of female attending physicians were at the assistant professor level (75.8% [94 of 124]) when compared with their male counterparts (24.4% [30 of 124]; P < 0.001). Conversely, there were a larger percentage of male attending physicians (62.2% [56 of 90]) at the professor level when compared with their female counterparts (37.8% [34 of 90]; P < 0.001). There was no difference in research productivity between male and female attending physicians after controlling for career length with the M-quotient (P = 0.65). Only age (odds ratio, 1.14; 95% confidence interval, 1.05-1.24) and the M-quotient (odds ratio, 36.17, 95% confidence interval, 8.57-152.73) were significantly associated with professorship. CONCLUSIONS: Our study found that there are more female attending physicians in FPMRS and that most are assistant professors. Male and female FPMRS attending physicians had similar research productivity with respect to their career lengths. Gender was not a determinant for achieving a "professor" appointment.

General Versus Regional Anesthesia in Sacrospinous Ligament Fixation for Pelvic Organ Prolapse: Assessment of a National Database.

IMPORTANCE: Sacrospinous ligament fixation is a prolapse repair surgical procedure that can be performed under general or regional anesthesia. Little is known about the impact of anesthesia on postoperative outcomes. OBJECTIVES: The primary objective of this study was to compare 30-day complication rates for patients undergoing sacrospinous ligament fixation by anesthesia type. Secondary objectives were to assess factors associated with type of anesthesia selected. STUDY DESIGN: This was a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program for the years of 2015 to 2020. Cases were selected based on procedural codes for sacrospinous ligament fixation and diagnostic codes for prolapse. Complications, readmissions, and reoperations were compared between general versus regional anesthesia cohorts. RESULTS: A total of 2,984 cases were included with 2,742 (91.9%) performed under general and 242 (8.1%) performed under regional anesthesia. The regional anesthesia cohort was older (69.2 vs 65.4 years old; P < 0.001) with no differences in medical history variables. Fewer patients in the regional anesthesia cohort were Hispanic (0.4% in regional vs 10.8% in general cohorts, P < 0.001). More superficial surgical site infections (2.5% vs 0.8%, P = 0.026) and cardiac complications (0.8% vs 0.1%, P = 0.035) were noted in the regional anesthesia cohort. However, multivariable regression analysis showed that anesthesia type was not associated with increased rates of minor or major complications. CONCLUSIONS: Mode of anesthesia was not a significant predictor of minor or major complications. Racial and ethnic differences in mode of anesthesia warrant further investigation to reduce racial disparities.

Sexual Harassment Prevalence Among OBGYN Trainees and Cultural Climate of their Training Programs: Result From a Nationwide Survey.

OBJECTIVE: Sexual harassment has many short- and long-term consequences and greatly impacts the clinical work environment, job satisfaction, job performance, and mental wellbeing of the individual. Data on prevalence of sexual harassment in a women-majority field such as Obstetrics and Gynecology (OBGYN) are limited. This national cross-sectional study sought to determine the prevalence of sexual harassment among OBGYN trainees in the United States (U.S.) and assess the associated departmental cultural climate. DESIGN, SETTING, PARTICIPANTS: This study was a cross-sectional, anonymous, voluntary, national survey of OBGYN residents and fellows in the U.S. conducted from May 1, 2019 to June 30, 2019. The validated Sexual Experience Questionnaire was administered via an online survey. Trainees were also queried regarding wellbeing, work satisfaction, and departmental/institutional reporting structure. Demographic data were also gathered. The main outcome was prevalence of sexual harassment among U.S. OBGYN trainees. RESULTS: An email including the survey link was distributed to 1473 OBGYN trainees from 60 programs; 366 completed it (24.8% response rate). The mean age of survey respondents was 30.5 (SD 2.9) years. The majority of respondents were women (86%), White (64.1%), and residents (PGY 1-4, 80.2%). The prevalence of sexual harassment among respondents was 69.1% (69.6% of men and 68.7% of women). The prevalence of sexual harassment by race/ethnicity was: Hispanic/Latina 75.0%, White 68.7%, Asian 68.6%, and Black 47.4% trainees. The majority of respondents' program directors were women (66.4%, 227/342) and the majority of department chairs were men (68.9%, 235/341). The prevalence of sexual harassment did not differ based on the gender of the respondents' program directors and chairs (p-value 0.93). CONCLUSIONS: There is a high prevalence of sexual harassment among U.S. OBGYN trainees. Action is required to improve institutional and departmental cultures.

Systematic Review of Pelvic Anatomy iOS and Android Applications for Obstetricians and Gynecologists.

IMPORTANCE: Resources for learning and enhancing knowledge in medicine, such as mobile applications (apps), have dramatically increased in recent years; however, there is lack of a valid source for identifying the best and most reliable mobile apps. OBJECTIVES: The goal of this study was to identify the highest scoring available pelvic anatomy apps based on quality, content, and functionality for obstetrician-gynecologists using a validated tool. STUDY DESIGN: This was a systematic evaluation of anatomy apps in the Apple iTunes (iOS) and Google Play (Android) stores. Exclusions included apps that had nonhuman, nonanatomy content, did not include female pelvic anatomy or were deemed inappropriate for postgraduate level. The validated Mobile App Rating Scale (MARS), a mobile-health (mHealth) app scoring system was used to evaluate apps based on both objective and subjective quality. The authors' MARS scores for each variable were compiled, and the objective, subjective, and overall scores were calculated. RESULTS: The search criteria yielded 2,432 apps: 952 (39%) Apple iTunes store and 1,480 (60.8%) Google Play Store apps. After applying the exclusion criteria, 35 (14 iOS, 8 Android, and 13 iOS/Android) apps were included for evaluation using the MARS system. "Complete Anatomy" app, available for both iOS and Android systems, obtained the highest objective, subjective, and overall MARS score. CONCLUSIONS: Although there are numerous anatomy apps available, only a few meet prespecified criteria for functionality, content, quality, and are appropriate for obstetrician-gynecologists. Using a validated scoring system, we present a scored list of female pelvic anatomy apps most appropriate for obstetrician-gynecologists.

Trends in Apical Suspension at the Time of Hysterectomy for Pelvic Organ Prolapse: Impact of American College of Obstetricians and Gynecologists Recommendations.

OBJECTIVE: The aim of the study was to compare national surgical practice patterns of performing apical suspension procedures (ASPs) at the time of hysterectomy for pelvic organ prolapse (POP) before and after the publication of the American College of Obstetricians and Gynecologists (ACOG) 2017 Practice Bulletin on POP. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for hysterectomy cases performed for POP indications for the years 2015-2016 and 2018-2019. The primary outcome was the use of ASP at the time of hysterectomy for POP. Secondary outcomes included the use of anterior, posterior, and paravaginal prolapse repair procedures. Multivariable regression analysis was performed to identify factors associated with performing a hysterectomy without an ASP. RESULTS: A total of 11,336 cases were included, and apical prolapse was the primary POP diagnosis in 86.3% of these cases. There was no statistically significant change in the utilization of ASPs in 2018-2019 compared with 2015-2016 (51.4% vs 49.8%, P = 0.081). Urogynecologists were significantly more likely than general gynecologists to perform ASPs (65.6% vs 37.5%, P < 0.001), which was confirmed on multivariable logistic regression analysis (adjusted odds ratio, 3.257; P < 0.001). The use of concomitant anterior repairs (44.1% vs 39.5%, P < 0.001) and posterior repairs (47.5% vs 41.3%, P < 0.001) increased in the 2018-2019 cohort. CONCLUSIONS: There was no overall increase in the utilization of concomitant ASPs at the time of hysterectomy done for POP indications despite the 2017 American College of Obstetricians and Gynecologists practice bulletin. Urogynecologists were more likely to perform ASPs than general gynecologists.

Complications After Vesicovaginal Fistula Repair Based on Surgeon Specialty in the United States: Analysis of a National Database.

OBJECTIVES: This study aimed to compare the rates of major and minor complications for vesicovaginal fistula (VVF) repair based on surgeon specialty and to identify risk factors for adverse outcomes. METHODS: This was a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program between the years 2014 and 2019. Cases were identified using Current Procedural Terminology codes for VVF repair. Minor and major complication rates for VVF repair were compared between 2 cohorts defined by surgeon specialty: gynecology versus urology. Additional outcomes included readmissions and reoperations. Multivariable logistic regression analysis was performed to investigate risk factors for complications. RESULTS: A total of 319 VVF repairs were included in the analysis, of which 115 (36.1%) were performed by gynecologists and 204 (63.9%) by urologists. There were no significant differences in the demographic or medical characteristics between the gynecology and urology cohorts except for race. Gynecologists performed more concomitant hysterectomies (10.4% vs 1.0%, P < 0.001) and apical suspension procedures (6.1% vs 0%, P < 0.001). There were no differences in minor (7.8% vs 6.4%, P = 0.623) or major (2.6% vs 3.4%, P = 1.000) complications between the cohorts. The overall readmission rate was 4.7%, and the reoperation rate was 2.2% with no differences between specialties. On multivariable logistic regression analysis, body mass index and concurrent hysterectomy were risk factors for major or minor complications with no increased risk associated with surgeon specialty or route of surgery. CONCLUSIONS: Complication rates did not differ for VVF repairs performed by gynecologists compared with urologists. Readmission and reoperation rates were low for both groups.

Money Matters: Anticipated Expense of In-Person Obstetrics and Gynecology Fellowship Interviews Has Greater Impact for Underrepresented in Medicine and Women Applicants.

Background: Much of the expense of pursuing subspecialty training in obstetrics and gynecology (ObGyn) is due to in-person fellowship interviews. Although interviews were converted to a virtual platform for the 2020 fellowship interview season in response to the COVID-19 pandemic, candidates anticipated in-person interview expenses at the time of their application. It is unknown whether financial considerations influenced candidates' decision to pursue fellowship training. This study aimed to evaluate the financial impact of anticipated in-person fellowship interviews among applicants of ObGyn subspecialties. Materials and Methods: This was a planned secondary analysis of a survey administered during the 2020 interview season to evaluate the effectiveness of virtual ObGyn fellowship subspecialty interviews in creating a rank list. Information was obtained about anticipated and actual interview costs, the need for securing additional funding and whether financial considerations influenced the decision to apply for fellowship. Results: In total, 158 participants enrolled in the 2020 National Resident Matching Program for ObGyn fellowship programs (48%) completed the web-based survey. Women and Black fellowship applicants were more likely than men (p = 0.044) and White applicants (p = 0.014) to endorse a need to secure additional funding for in-person fellowship interviews. In addition, Hispanic and Black applicants were more likely than White applicants to report that the financial impact of fellowship interviews influenced the decision to apply "somewhat" or "to a great extent" (p = 0.025 and p < 0.001, respectively). Conclusions: The costs of applying to ObGyn fellowship programs may disproportionately affect women and underrepresented in medicine applicants. By reducing a financial barrier, virtual interviews may help promote greater gender and racial and ethnic diversity in ObGyn subspecialty pursuit.

The American Urogynecologic Society Action Plan on Diversity, Equity, and Inclusion: Developed by the Diversity, Equity, and Inclusion Task Force.

ABSTRACT: The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions. The charge was intentionally broad. In review of the literature, there was little to inform the best means to proceed aside from administering climate surveys to gauge the current culture of inclusion and bias. The task force believed that the challenge was not only to describe the problem but also to articulate solutions. We ultimately moved to rewrite the Diversity and Inclusion and Code of Conduct Statements and develop an Action Plan that would accelerate the efforts of AUGS to foster inclusion and improve equity through the existing governance structure. In this document, we describe how the task force was organized and conducted the work to develop strategies that were aligned with the AUGS mission: "As the leader in female pelvic medicine and reconstructive surgery, AUGS drives excellence in care for women through education, research, advocacy, and interdisciplinary collaboration."