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Objective: The aims of this retrospective cohort study were to determine the proportion of women on medical therapy to correct anemia, defined as hemoglobin <12.0g/dL prior to myomectomy and to determine the association between preoperative optimization and transfusion rates, accounting for preoperative anemia. Materials and Methods: Patients undergoing myomectomy (open, laparoscopic, or robot-assisted) between February 2015 and June 2018 at a single high-volume academic hospital were included. Results: There were 224 patients who underwent open (70.5%), laparoscopic (10.7%), or robotic (18.8%) myomectomy, with 30.4% (n = 68) anemic immediately prior to surgery. Of those patients, 76.5% (n = 52) received medical preoperative optimization before surgery: 23 (33.8%) had iron therapy alone; 16 (23.5%) had hormonal therapy alone; 12 (17.7%) had iron and hormonal therapy; and 9 (13%) had tranexamic acid. Perioperative blood transfusion—a transfusion given intraoperatively or within 2 days postoperatively was given to 32 (14.3%) patients; 84.4% (n = 27) were open cases. Half (n = 16) of the transfused patients were anemic before surgery and 25% were not receiving preoperative medical optimization. Preoperative anemia significantly increased the odds of perioperative blood transfusion (odds ratio [OR] = 2.69, 95% confidence interval [CI] :1.26–5.77; p = 0.011). Taking medications prior to surgery did not affect the odds of receiving transfusion across all patients, including those with preoperative anemia (adjusted OR = 0.87; 95% CI: 0.38–1.98; p = 0.732). Conclusions: One quarter of transfused patients were not on medications preoperatively despite being anemic. An attempt should be made to optimize and correct anemia actively prior to myomectomy, particularly for a planned open procedure. (J GYNECOL SURG 38:120) [ABSTRACT FROM AUTHOR]

Objective: Avoiding surgical delay in the operating room (OR) is essential to provide timely, safe, and cost-effective care. The objective of this study was to identify the causes of OR delays and assess trends related to surgical specialties or approaches. Materials and Methods: This retrospective study included all elective gynecology (Gyn), general surgery (GS), and urology (Uro) surgeries performed during a 12-month period. Operative case details, surgical times, and reasons for delays were retrieved from a perioperative database. Representative specialty-specific procedures (hysterectomy, colectomy, nephrectomy) were chosen and compared separately to assess trends in delays. Results: A total of 4206 surgeries were completed during the study period; of which 1447 (34%) were Gyn, 2226 (52%) GS, and 533 (12%) Uro. Delays occurred in 1010 Gyn (70%), 1304 GS (59%), and 225 Uro cases (48%). The most-common reason for delay was case-related—delays in case due to delays in prior cases—(n = 1171 [28%]), followed by patient-related delays (n = 458 [11%]), then delays in patient preparedness (n = 340 [8%]). These rates of delay frequency were similar across representative specialty-specific procedures. Delays were more frequent when comparing laparoscopic to open colectomy (38/51, 75% versus 24/25, 96%; p = 0.02), whereas there was no significant difference in delays between laparoscopic and open hysterectomy (162/198, 82% versus 50/68, 74%; p = 0.07) or nephrectomy (4/7, 57% versus 35/76, 46%; p = 0.70). Conclusions: This study suggests that among specialties and cases, the most-common cause of delays was case-related. These findings provide a platform from which to introduce quality-improvement initiatives. (J GYNECOL SURG 36:109) [ABSTRACT FROM AUTHOR]

Up to 40% of patients aged ≤55 years undergo concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy, with practice variation in bilateral salpingo-oophorectomy occurring along the lines of patient health and social factors. Disability is common in premenopausal women and is an important determinant of reproductive health more broadly; however, studies on bilateral salpingo-oophorectomy rates among women with disabilities are lacking. This study aimed to examine whether the use of concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy differs by preexisting disability status in adult females aged ≤55 years. This population-based cross-sectional study used data from the 2016–2019 US National Inpatient Sample. Females undergoing inpatient hysterectomy for a benign gynecologic indication (n=74,315) were classified as having physical (6.1%), sensory (0.1%), intellectual or developmental (0.2%), or multiple (0.2%) disabilities and compared with those without a disability. Logistic regression was used to estimate risk ratios for differences in bilateral salpingo-oophorectomy rates by disability status, adjusted for patient and clinical factors. Models were stratified by potentially avoidable or potentially appropriate bilateral salpingo-oophorectomy based on the presence of clinical indications for ovarian removal and by age group. Bilateral salpingo-oophorectomy at the time of benign hysterectomy occurred in 26.0% of females without a disability, with rates clearly elevated in those with a physical (33.2%; adjusted risk ratio, 1.10; 95% confidence interval, 1.05–1.14) or intellectual or developmental (31.1%; adjusted risk ratio, 1.32; 95% confidence interval, 1.02–1.64) disability, possibly elevated in those with multiple disabilities (38.2%; adjusted risk ratio, 1.20; 95% confidence interval, 0.94–1.45), and similar in those with a sensory disability (31.2%; adjusted risk ratio, 0.98; 95% confidence interval, 0.83–1.13). The results were similar but with lower statistical precision for potentially avoidable and potentially appropriate bilateral salpingo-oophorectomy, which occurred in 9.1% and 17.0% of females without a disability, respectively. The largest differences in bilateral salpingo-oophorectomy rates among women with any disability were observed in the perimenopausal 45- to 49-year age group. Females with disabilities experienced elevated concomitant bilateral salpingo-oophorectomy rates at the time of benign hysterectomy, particularly those with an intellectual or developmental disability and those of perimenopausal age, although some estimates were imprecise. Equity-focused physician training in surgical counseling and research into the epidemiology and experiences of gynecologic conditions among females with a disability may be beneficial. [ABSTRACT FROM AUTHOR]