Urogynecology (Philadelphia, Pa.) · 2022
Effect of Time of Year on Surgical Outcomes in Patients Undergoing Minimally Invasive Sacral Colpopexy or Uterosacral Ligament Suspension.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Renkosiak Kaitlin, Bradley Megan, Dubinskaya Alexandra, Shepherd Jonathan P
Аннотация
IMPORTANCE: Academic urogynecologists incorporating fellows/residents into operative cases must ensure safety and quality outcomes throughout the learning curve of the academic year.
OBJECTIVES: We evaluated if the month of year relative to fellow/resident promotions in July affects operating time, complications, and prolapse recurrence for minimally invasive sacral colpopexy (MISC) or uterosacral ligament suspension (USLS).
STUDY DESIGN: This was a retrospective study comprising MISC and USLS from January 2009 to August 2015. Patient demographics, clinical, and surgical data were compared between months with July as month 1. Linear regression assessed operating time. Logistic regression assessed prolapse recurrence (composite of any POP-Q point beyond the hymen, pessary use, or reoperation) and complications.
RESULTS: One thousand seven participants had a mean age of 59.9 ± 9.4, body mass index of 27.6 ± 4.2, gravity of 3.0 ± 1.5, and parity of 2.6 ± 1.1. Most had stage III (67.7%) or II prolapse (25.6%). Minimally invasive sacral colpopexy represented 81.0% (58.8% laparoscopic, 41.2% robotic). Uterosacral ligament suspensions were 68.1% vaginal versus laparoscopic/robotic. Median follow-up was 34 weeks (interquartile range, 11-82). Mean operating time was 199.8 ± 66.4 minutes with no impact by month ( P = 0.26). Minimally invasive sacral colpopexy (vs USLS, β = 36.4 minutes), conversion to laparotomy (β = 112.9 minutes), and concomitant hysterectomy (β = 33.4 minutes) increased operating time ( P < 0.001). Complications ranged 7.9% (January) to 23.8% (March) with mean of 17.1%. Complications were unaffected by month (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.04), but USLS had more complications than MISC (OR, 1.55; 95% CI, 1.05-2.28). Prolapse recurred in 9.4% with no impact by month (OR, 0.95; 95% CI, 0.88-1.02). Minimally invasive sacral colpopexy had less recurrence than USLS (OR, 0.33; 95% CI, 0.18-0.60).
CONCLUSIONS: Month of year relative to resident/fellow promotion did not affect operating time, complications, or recurrence, debunking the myth of worse outcomes earlier in the academic year.
OBJECTIVES: We evaluated if the month of year relative to fellow/resident promotions in July affects operating time, complications, and prolapse recurrence for minimally invasive sacral colpopexy (MISC) or uterosacral ligament suspension (USLS).
STUDY DESIGN: This was a retrospective study comprising MISC and USLS from January 2009 to August 2015. Patient demographics, clinical, and surgical data were compared between months with July as month 1. Linear regression assessed operating time. Logistic regression assessed prolapse recurrence (composite of any POP-Q point beyond the hymen, pessary use, or reoperation) and complications.
RESULTS: One thousand seven participants had a mean age of 59.9 ± 9.4, body mass index of 27.6 ± 4.2, gravity of 3.0 ± 1.5, and parity of 2.6 ± 1.1. Most had stage III (67.7%) or II prolapse (25.6%). Minimally invasive sacral colpopexy represented 81.0% (58.8% laparoscopic, 41.2% robotic). Uterosacral ligament suspensions were 68.1% vaginal versus laparoscopic/robotic. Median follow-up was 34 weeks (interquartile range, 11-82). Mean operating time was 199.8 ± 66.4 minutes with no impact by month ( P = 0.26). Minimally invasive sacral colpopexy (vs USLS, β = 36.4 minutes), conversion to laparotomy (β = 112.9 minutes), and concomitant hysterectomy (β = 33.4 minutes) increased operating time ( P < 0.001). Complications ranged 7.9% (January) to 23.8% (March) with mean of 17.1%. Complications were unaffected by month (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95-1.04), but USLS had more complications than MISC (OR, 1.55; 95% CI, 1.05-2.28). Prolapse recurred in 9.4% with no impact by month (OR, 0.95; 95% CI, 0.88-1.02). Minimally invasive sacral colpopexy had less recurrence than USLS (OR, 0.33; 95% CI, 0.18-0.60).
CONCLUSIONS: Month of year relative to resident/fellow promotion did not affect operating time, complications, or recurrence, debunking the myth of worse outcomes earlier in the academic year.