Hospital versus individual surgeon’s performance in laparoscopic hysterectomy

Purpose

To compare hospital versus individual surgeon’s perioperative outcomes for laparoscopic hysterectomy (LH), and to assess the relationship between surgeon experience and perioperative outcomes.

Methods

A retrospective analysis of all prospective collected LHs performed from 2003 to 2010 at one medical center was performed. Perioperative outcomes (operative time, blood loss, complication rate) were assessed on both a hospital level and surgeon level using Cumulative Observed minus Expected performance graphs.

Results

A total of 1618 LHs were performed, 16 % total laparoscopic hysterectomies and 84 % laparoscopic supracervical hysterectomies. Overall outcomes included mean (SD±) blood loss 108.9 ± 69.2 mL, mean operative time 95.4 ± 39.7 min and a complication occurred in 76 (4.7 %) of cases. Suboptimal perioperative outcomes of an individual surgeon were not always detected on a hospital level. However, collective suboptimal outcomes were faster detected on a hospital level compared to individual surgeon’s level. Evidence of a learning curve is seen; for the first 100 procedures, a decrease in operative time is observed as individual surgeon experience increases. Similarly, the risk of conversion decreases up to the first 50 procedures.

Conclusion

An individual outlier (i.e., surgeon with consistently suboptimal performance) will not always be detected when monitoring outcome measures only on a hospital level. However, monitoring outcome measures on a hospital level will detect suboptimal performance earlier compared to monitoring only on an individual surgeon’s level. To detect performance outliers timely, insight into an individual surgeon’s outcome and skills is recommended. Furthermore, an experienced surgeon is no guarantee for acceptable surgical outcomes.

     

Hemabate® for the Management of Post-partum Haemorrhage in a Rural Hospital

Objective: Hemabate® (15-methyl-prostaglandin F_2α) is a relatively new and effective medication for the control of post-partum haemorrhage (PPH). The authors review the literature on the management of PPH, describe their experience with this medication and present the results of a survey of Northern Ontario obstetrical services.Quality of Evidence: numerous studies have demonstrated the effectiveness of Hemabate® for the management of PPH. Despite recommendations regarding its appropriate use in the Advances in Labour and Risk Management (ALARM)¹ and Advanced Life Support in Obstetrics (ALSO)² course guidelines, as well as published reports in the Journal of the Society of Obstetricians and Gynaecologists of Canada (SOGC),^3,4 the availability of this medication is somewhat limited in the rural hospitals we surveyed in Northern Ontario.Main Message: Hemabate® is a safe, effective drug for the management of PPH when oxytocin and manual massage and evacuation of the uterus have failed. It is especially useful in rural settings where access to resources may be limited.Conclusion: the authors recommend the more widespread availability and use of Hemabate®, particularly in rural settings.     

Unsuspected Uterine Sarcoma in an Urban Hospital: Does Surgical Approach Matter?

Study Objective

To compare the incidence of unsuspected uterine sarcoma based on surgical approach, open versus minimally invasive, for myomectomy and hysterectomy.

Trends in maternal mortality over 29 years in a Kuwait Tertiary Teaching Hospital: signs of progress?

This study aims at (1) Assessing trends in maternal mortality in kuwait (2) Define strategies for prevention. Methods: Retrospective analysis of maternal deaths that occurred among, 55,979 live births at a tertiary hospital, between 1980 and 2009. Results: There were 14 maternal deaths, and 55,979 live births, giving a maternal mortality rate of 25 per 100,000 live birth. In terms of decades maternal mortality declined from 54.8 in 1980–90 to 28.4 in 1990–2000 and continued to decline to 12.2 in 2000–2009. Thromboembolism (28.6%), Obstetric haemorrhage (21.5%) and Eclampsia (14.3%) were the leading causes of direct deaths. Cardiac disease is the most common cause of indirect deaths (14.3%) followed by H1N1 pneumonia 7.1%. Eclampsia contributed to 40% of deaths, only in the 1980s. Thromboembolism caused 28.6% of deaths, 50% of which were in the last 9 years. Indirect deaths from cardiomyopathies (66.7%) gained prominence in the 1990s. No deaths from puerperal sepsis were reported after the 1980s (14.3%). Conclusions: Maternal mortality rates are decreasing significantly (p?<?0.01) at our institution over the last 29 years. Obstetric haemorrhage and thromboembolism remain important causes of maternal mortality. Substandard care was identified in 70% of Direct and 55% of indirect deaths.     

Where Are We in Terms of Sexual Health Education? An Ontario Perspective

In the present study, sexual health educators in schools in the catchment area for the Children's Hospital of Eastern Ontario were surveyed to determine whether sexual health education programs were available to youth, whether the structure and content of sexual health education programs followed the guidelines, the instructors’ qualifications and level of comfort with the material, and the need for additional resources that could be offered by health care professionals. Survey results showed that only 85% of participating schools had a sexual health education program in place. Only one-third of educators stated they had formal training on the topic of sexual health. Some schools still taught mostly about abstinence or advocated condom use for contraception. The results showed that many of these schools did not follow established Canadian guidelines for sexual health education. Nonetheless, 80% of Canadian adolescents report school as their most valuable source of information on sexuality.     

Advances in Resident Education: The Introduction of a Computerized Learning Portfolio—Koala

Medical educators strive to inspire students to be “learners for life,” to take responsibility for identifying their learning needs, select quality learning activities, and critically evaluate performance outcomes. Self-directedness in learning has become an established goal of curricular reform in undergraduate medical education and a necessary attribute of the professional in practice.This article details our experience with an educational initiative to enhance self-directed learning in the “middle” learner in the learning continuum. The residents involved used a computerized learning portfolio, Computerized Obstetrics and Gynaecology Automated Learning Analysis (KOALA).     

Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies—A Resident Physician Survey

BackgroundMany women will experience a sexual health concern and present to their Obstetrics and Gynecology (Ob-Gyn) care provider, yet a large portion of graduating Ob-Gyn resident physicians in the United States may not feel comfortable helping patients with some sexual health issues.AimTo perform a cross-sectional study of U.S. Ob-Gyn resident physicians that assesses sexual health education didactic sessions and comfort level with sexual health clinical vignettes.MethodsA 32-item anonymous survey was sent to all 4,065 Ob-Gyn residents on June 7, 2016. Respondents voluntarily completed the survey electronically.OutcomesThe primary outcome measures are the comfort level of Ob-Gyn resident physicians in taking a sexual history and providing counseling to patients represented in clinical vignettes, which were based on sexual health learning objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG).ResultsOf the 4,065 eligible U.S. examinees, 968 (23.8%) agreed to participate in the study, and 802 (19.7%) completed the survey and were included in the final analysis. Nearly two-thirds of the residents indicated that sexual health training was a priority in residency. However, more than half were not able to describe the disorders of sexual function or list common medications that effect sexual function. When posed with clinical vignettes, residents felt very comfortable obtaining a sexual history (98.5%) and providing counseling (97.0%) for a 16-year-old seeking contraception, yet fewer felt very comfortable obtaining a history and providing counseling for a 26-year-old who is a refugee from Somalia (77.2% and 73.8%). Smaller cohorts felt prepared to take a sexual history and provide counseling for a 17-year-old who discloses that she is a victim of sex trafficking (61.2% and 57.7%), and for a 58-year-old transgender patient planning hormone therapy and surgery (49.9% and 37.9%). In logistic regression analysis, the factors that were influential in an Ob-Gyn resident physician's program to prepare them to describe the disorders of sexual function were post-graduate year (OR 1.387, 95% CI 1.189, 1.618; P = .0001), those that rated the importance of a sexual health curriculum highly (OR 0.701, 95% CI 0.569, 0.864; P = .0012), and a greater number of didactic sessions on sexual health in the residency curriculum (OR 0.685, 95% CI 0.626, 0.750; P < .0001).ConclusionThese findings highlight strengths in the comfort of Ob-Gyn resident physicians about sexual health and illustrate areas of opportunity to engage resident learners by improving the sexual health curriculum.Worly B, Manriquez M, Stagg A, et al. Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies—A Resident Physician Survey. J Sex Med 2021;18:1042–1052.     

Characteristics of threats to pregnancy and labour in women over 39 y.o. in material of the District Hospital no. 2 in Rzeszów

OBJECTIVE: Comparison of obstetric results in women giving birth in age over 39 and those of younger women. MATERIALS AND METHODS: Retrospective analysis of 12 575 labours in the Department of Obstetrics of the District Hospital no. 2 in Rzeszów. Demographic and obstetric data, pregnancy complications, labour method, indications for caesarean section and obstetric results (pregnancy duration, mortality of mothers, perinatal mortality, birth weight, general status of neonates, necessity for neonate treatment in ICU) were compared to three reference groups: of women below 25 y.o., between 25 and 34 y.o., and between 35 and 39 y.o. RESULTS: Statistically significant difference (p = 0.001) was shown between the study group and reference groups in scope of: pregnancy duration, frequency of pregnancy complications and frequency of birth by caesarean section. Differences concerning the other analysed parameters were not statistically significant. CONCLUSIONS: It was concluded that mother's age over 39 y.o. is connected with shorter pregnancy duration, more frequent occurrence of pregnancy complications and more frequent birth by caesarean section.