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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]

Abstract: Objective: Oral progestin is an alternative to hysterectomy for women with complex atypical hyperplasia (CAH) or grade one endometrial cancer (G1EC) who wish fertility preservation. We evaluated treatment efficacy and fertility outcomes in this population. Methods: Women <45y treated with oral progestin for CAH or G1EC were identified from two cancer centers. Data were obtained from medical records and telephone questionnaires. Time until complete response (CR), and from CR until recurrence was censored for patients without events and analyzed for associations with patient and treatment characteristics; cumulative incidence functions were used to estimate event probability over time. Results: 44 patients were identified, 19 (43%) with CAH and 25 (57%) with G1EC. Median age was 36.5y (26–44). 24 (55%) achieved CR (median time: 5.7months). Older age was associated with a lower likelihood of CR (HR 0.84, p=0.0003, 95% CI, 0.8–0.9). CR probability appeared to plateau after 12months of therapy. Among those with CR, 13 (54%) recurred (median time 3.5y). 24 patients (55%) underwent hysterectomy; 3 (13%) were upstaged. 11 (25%) underwent fertility treatment with the following outcomes: 6 (55%) no pregnancy, 2 (18%) at least one live infant, and 3 (27%) spontaneous abortion. One achieved a live birth without intervention. Conclusion: Oral progestin is an effective temporizing fertility-sparing treatment for women with CAH/G1EC. Fertility specialist involvement is recommended due to the low live birth rate without intervention. Progestin therapy should be re-evaluated at 1year in non-responders due to a low probability of success. Hysterectomy is recommended after childbearing due to a high recurrence rate. [Copyright &y& Elsevier]