Search

To study if separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection (SSI) rates. A retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery (MIGS) subspecialists from 1/2016 through 5/2023. Conventional TLHs. A total of 680 patients, of which 377 (55.4%) underwent TLH by Surgeon 1 and 303 (44.6%) by Surgeon 2. Preoperative antibiotic prophylaxis was administered per formal guidelines. All patients underwent perineal-vaginal preparation and separate abdominal preparation. Surgeon 1 performed surgeries with surgical field separation, which included glove changes of the top gloves when crossing fields, while Surgeon 2 performed surgeries without changes. The two surgeons had access to the same operating rooms, staff, trainees, anesthesiology group and instruments sterilization process. Data was collected from the electronic medical record. We assessed characteristics and outcomes of patients who underwent TLH with Surgeon 1 and Surgeon 2. The primary outcome was the occurrence of any postoperative infection within 30 days of surgery. The overall SSI rate was 1.0%. The occurrence of any infection was 0.8% (3/377) for Surgeon 1 vs. 1.3% [4/303, OR 95% CI 0.60 (0.13-2.70)] for Surgeon 2, including superficial incisional, deep incisional, organ/space, and urinary tract infections. All patients who had SSIs also received antibiotic prophylaxis during surgery. The occurrence of readmission, reoperation or vaginal cuff dehiscence was also low in both groups. The infection rate after TLH is low with or without surgical field separation, and our overall infection rate fell on the lower end of the reported range. Additional information on the need for surgical field separation is important because most emissions created by the healthcare system come from single-use items in the supply chain. [ABSTRACT FROM AUTHOR]

To evaluate patient satisfaction with in-person versus virtual visits among minimally invasive gynecologic surgery (MIGS) patients. Retrospective cohort study comparing satisfaction scores of patients who had virtual visits versus in-person visits. An urban quaternary care center from 4/2015-7/2023. We included patients who had the same type of visit, either virtual or in-office, before and after surgery, and responded to the surveys on both time points. Eight patient satisfaction questions were analyzed to assess satisfaction with the visit, provider, and office staff. The study included 349 patients, 262 in the virtual group and 87 in the in-person group. Patients who had virtual visits were younger (37.2 vs. 42.2 years, p<0.003) and less likely to be smokers (1.8% vs 8.0%, p<0.001). Patients who underwent hysteroscopy (4.2% vs. 16.1%, p<0.001) or robotic surgery (1.5% vs. 10.3%, p<0.001) were more likely to be seen in the office, while patients who underwent laparoscopic hysterectomy (21.8% vs. 33.3%, p=0.004) or endometriosis excision (20.2% vs. 18.4%, p<0.001) were more likely to be seen virtually. There was no difference in total hospital admission length. Patient satisfaction surveys for patients seen virtually had significantly higher overall scores for the facility (9.46 vs. 8.94, p<0.001), they were more likely to recommend the practice to their friends and family (9.56 vs 8.88, p<0.001), and felt more that staff did everything possible to help with their discomfort (3.69 vs 3.44, p<0.001). There was no significant difference noted for all other survey questions. We found that compared to patients who had in-person visits, those who had virtual visits before and after gynecologic surgery reported higher satisfaction scores when asked about the medical facility and the medical staff, while other satisfaction scores were comparable. [ABSTRACT FROM AUTHOR]

The clinical diagnosis of major depressive disorder (MDD) still depends on subjective information in terms of various symptoms regarding mood. Detecting the characterization of extracellular vesicles (EVs) in blood may result in finding a diagnostic biomarker that reflects the depressive stage of patients with MDD. Here, we report the results on the glycosylation pattern of enriched plasma EVs from patients with MDD. We compared glycosylation patterns by lectin blotting expressed in EVs isolated from the plasma of both patients with MDD and age-matched healthy control participants (HCs) using size-exclusion chromatography. The levels of Wheat germ agglutinin (WGA), N-acetyl glucosamine (GlcNAc), and N-Acetylneuraminic acid (Neu5Ac, sialic acid) - binding lectin, were significantly decreased in patients with MDD in the depressive state compared to HCs and in remission state. Furthermore, proteome analysis revealed that the von Willebrand factor (vWF) was a significant factor recognized by WGA. WGA-binding vWF antigen differentiated patients with MDD versus HCs and the same patients with MDD in a depressive versus remission state. In this study, the change patterns in the glycoproteins contained in plasma EVs support the usability of testing to identify patients who are at increased risk of depression during antidepressant treatment., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

We aimed to study whether separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection rates. This was a retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery subspecialists between January 2016 and May 2023. Among 680 included patients, the rate of infection was 0.8% with surgical field separation and 1.3% without (3/377 vs 4/303; odds ratio 0.60, 95% CI, 0.13-2.70). There was no statistical difference between groups; however, the difference in infection rates between groups was extremely small, which led to inadequate power. Our findings suggest that rates of infection after TLH are low, with or without surgical field separation. Treating the vagina, perineum, and abdomen as a single, continuous operative field during TLH may be an acceptable practice., Competing Interests: Financial Disclosure Rebecca Schneyer reports money was paid to her institution by Ethicon for her efforts in this study. Matthew Siedhoff reports receiving payment from Applied Medical. The other authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Study Objective: To determine the utility of routine postoperative vaginal cuff examination for detection of vaginal cuff dehiscence (VCD) after total laparoscopic hysterectomy (TLH)., Design: Retrospective cohort study., Setting: Quaternary care academic hospital in the United States., Patients: All patients who underwent TLH with a minimally invasive gynecologic surgeon at our institution from 2016 to 2022., Interventions: Laparoscopic hysterectomy with routine vaginal cuff check 6 to 8 weeks postoperatively and laparoscopic hysterectomy without routine vaginal cuff check., Measurements and Main Results: We identified 703 patients who underwent TLH, 216 (30.7%) with routine cuff checks and 487 (69.3%) without. Within the no cuff check group, 287 (58.9%) had entirely virtual follow-up. There was no difference in VCD between the routine cuff check (1.28%, n = 2) and no cuff check groups (0.93%, n = 7, p = .73). Median time to VCD was 70.0 days (27.5-114.0). No VCDs were identified in asymptomatic patients on routine examination, and both patients in the cuff check group with VCD had appropriately healing cuffs on routine examination. In the cuff check group, 7 patients (3.2%) had findings of incomplete healing requiring intervention (silver nitrate, extended pelvic rest), all of whom were asymptomatic at the time of examination. Eight patients (3.7%) in the routine cuff check group and 21 (4.3%) in the no examination group required a nonroutine cuff check owing to symptoms. There was no difference in points of contact for postoperative symptoms between the groups (median 0 [0-1.0] for both groups, p = .778)., Conclusion: Routine postoperative vaginal cuff examination does not seem to affect or negate the risk of future VCD. Virtual follow-up for asymptomatic patients may be appropriate after TLH., (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: Recurrent urinary tract infections (rUTIs) are a burden to patients and the health care economy. Vaginal probiotics and supplements have gained significant attention in mainstream media and lay press as a non-antibiotic alternative. We performed a systematic review to determine whether vaginal probiotics are an effective means of prophylaxis for rUTI., Methods: A PubMed/MEDLINE article search was performed from inception to August 2022 for prospective, in vivo use of vaginal suppositories for the prevention of rUTIs. Search terms included: vaginal probiotic suppository (34 results), vaginal probiotic randomized (184 results), vaginal probiotic prevention (441 results), vaginal probiotic UTI (21 results), and vaginal probiotic urinary tract infection (91 results). A total of 771 article titles and abstracts were screened., Results: A total of 8 articles fit the inclusion criteria and were reviewed and summarized. Four were randomized controlled trials, with 3 of the studies having a placebo arm. Three were prospective cohort studies, and 1 was a single arm, open label trial. Five of the 7 articles that specifically evaluated for rUTI reduction with vaginal suppositories did find a decreased incidence with probiotic use; however, only 2 had statistically significant results. Both of these were studies of Lactobacillus crispatus and were not randomized. Three studies demonstrated the efficacy and safety of Lactobacillus as a vaginal suppository., Conclusion: Current data support the use of vaginal suppositories containing Lactobacillus as a safe, non-antibiotic measure, but actual reduction of rUTI in susceptible women remains inconclusive. The appropriate dosing and duration of therapy remain unknown., (© 2023. The Author(s).)

Background: There is a well-established relationship between surgical volume and outcomes after complex pediatric operations. However, this relationship remains unclear for common pediatric procedures. The aim of our study was to investigate the effect of hospital volume on outcomes after hypertrophic pyloric stenosis (HPS)., Methods: The Kid's Inpatient Database (2003-2012) was queried for patients with congenital HPS, who underwent pyloromyotomy. Hospitals were stratified based on case volume. Low-volume hospitals performed the lowest quartile of pyloromyotomies per year and high-volume hospitals managed the highest quartile. Outcomes included complications, mortality, length of stay (LOS), and cost., Results: Overall, 2137 hospitals performed 51,792 pyloromyotomies. The majority were low-volume hospitals (n = 1806). High-volume hospitals comprised mostly children's hospitals (68%) and teaching hospitals (96.1%). The overall mortality rate was 0.1% and median LOS was 2 d. High-volume hospitals had lower overall complications (1.8% versus 2.5%, P < 0.01) and fewer patients with prolonged LOS (17.0% versus 23.5%, P < 0.01) but had similar rates of individual complications, similar mortality, and equivalent median LOS as low-volume hospitals. High-volume hospitals also had higher costs by $1132 per patient ($5494 versus $4362, P < 0.01). Regional variations in outcomes and costs exist with higher complication rates in the West and lower costs in the South. There was no association between mortality or LOS with hospital volume or region., Conclusions: Patients with pyloric stenosis treated at high-volume hospitals had no clinically significant difference in outcomes despite having higher costs. Although high-volume hospitals offer improved outcomes after complex pediatric surgeries, they may not provide a significant advantage over low-volume hospitals in managing common pediatric procedures, such as pyloromyotomy for congenital HPS., (Copyright © 2018 Elsevier Inc. All rights reserved.)