Objective The aims of this study were to design and to validate a surgical simulation model for vaginal anterior colporrhaphy. Methods Obstetrics and gynecology residents were divided into two groups: “novice” and “advanced.” “Expert” group comprised female pelvic medicine and reconstructive surgery (FPMRS) fellows and faculty. All subjects were recorded performing anterior colporrhaphy using the simulation model. Deidentified, silent videos of recorded performances were evaluated by a blinded reviewer using the Objective Structured Assessment of Technical Skills (OSATS) and a procedure-specific assessment, based on the American Board of Obstetrics and Gynecology milestone evaluation. Analysis of variance was used for statistical comparisons. Results Thirty-seven participants included 13 novices, 18 advanced residents, and six experts. The experts scored significantly higher than both resident groups in each of the domains of the OSATS and the procedure assessment. The mean OSATS score for experts was 32.30 (±6.06) (maximum, 35); novice, 17.15 (±5.84); and advanced, 21.11 (±5.61) (P = 0.001). The experts’ scores for the procedure assessment (maximum, 25) was 23.00 (±3.95); novice, 10.62 (±4.70); and advanced, 14.33 (±4.73) (P < 0.001). The two trainee groups did not differ significantly in their overall performance. Most trainees (29 [94%]) evaluated the model as a useful tool in learning this procedure. Conclusions This low-fidelity model can be constructed easily using common materials. The model cost is $43.92 with reusable components ($11 per use). Higher scores by experts versus trainees confirm construct validity of this model. It may serve as a valuable simulation tool allowing trainees to improve their surgical technique for anterior colporrhaphy.
Importance This study was performed to understand opioid consumption after midurethral sling (MUS) procedures to provide surgeons with guidelines on appropriate prescription regimens. Objective This study aimed to evaluate postdischarge narcotic use (PDNU) after MUS surgery using a restrictive postdischarge opioid regimen. Study Design This prospective clinical practice study included women undergoing MUS surgery from December 2018 to October 2019. Patients were discharged with an electronic prescription for 5 tablets of an oral narcotic. Brief Pain Inventory (BPI) surveys were collected preoperatively. Patients answered questions regarding remaining number of opioid tablets, BPI scores, and patient satisfaction on day 1, week 1 (postoperative week [POW] 1), and 4–6 weeks (POW4–6) postoperatively. Electronic records were reviewed to determine narcotic refills. Primary outcome was PDNU measured in morphine milligram equivalents (MME). Secondary outcomes evaluated refill rate, BPI scores, and patient satisfaction. Standard statistical tests were applied. Results Fifty-six patients were included in the analysis. Total median (interquartile range) PDNU was 12.5 (0–37.5) MME at POW1 and 15.0 (0–37.5) MME at POW4–6, which is approximately equivalent to 2 oxycodone (5 mg) tablets. Eighteen patients (32.1%) took 0 narcotics postdischarge. Brief Pain Inventory scores showed that “worst pain” was highest on postoperative day 1 with a median (interquartile range) score of 6 (4–8). At the POW1 and POW4–6 mark, 94.3% and 92% of patients, respectively, were satisfied or extremely satisfied with their pain control. Seven patients (11.8%) required a refill. Conclusions Most patients undergoing MUS surgery used no more than 2 oxycodone (5 mg) tablets during their 6-week postoperative course, with almost a third not requiring any narcotics. Low pain scores and high patient satisfaction rates were noted.
Importance An evaluation of Enhanced Recovery After Surgery (ERAS) effect on perioperative patient phone calls. Objective The aim of this study was to compare perioperative patient phone calls before and after implementation of ERAS. Study Design This is a retrospective chart review of women who underwent surgery by urogynecologists where ERAS was implemented. Patients who underwent surgery were identified before the implementation and compared with the same time period after implementation. Perioperative phone calls were reviewed and categorized by reason for call. Differences between the 2 groups were compared with a Student t test if normally distributed or with a Mann-Whitney U test if not. Categorical outcomes were reported with a percentage and compared with a χ 2 test with an α level of 0.05. Results We reviewed 387 records. There was no difference in the percentage of patient calls before and after implementation of ERAS (preoperatively: 19.8% vs 25.1% [P = 0.21], postoperatively: 64.1% vs 61.5% [P = 0.61]). Questions about chronic home medications were the most common reasons for calling before surgery (pre-ERAS: 16 [42.1%]; post-ERAS: 12 [28.6%]). Questions related to medications, pain, and bowels were the top reasons people called postoperatively. These remained the top 3 in the post-ERAS time period; however, bowel-related questions switched with medications for the top reason. Conclusions Despite patient education being an essential component of ERAS with written and verbal instructions provided, our study found no difference in preoperative or postoperative calls with the implementation. By focusing on common concerns, we may be able to improve the patients experience and reduce office phone calls.
Importance Accurate diagnosis of urinary tract infection after pelvic organ prolapse (POP) surgery is essential to postoperative care. Objective Our aim was to determine the agreement between the urinalysis of a clean-catch versus a straight catheter urine specimen in women who underwent vaginal surgery for POP. Study Design This was a cross-sectional study evaluating patients after vaginal surgery for POP. A clean-catch and straight catheter urine specimen were collected at routine postoperative appointments. Routine urinalyses and urine cultures were performed for all patients. A urine culture yielding mixed urogenital flora (which includes Lactobacillus species), coagulase-negative staphylococci, and Streptococcus species was considered a contaminated result. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter at 3 weeks postoperatively was evaluated using weighted κ statistic. Results Fifty-nine participants enrolled. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter was poor (κ = 0.018). The urine culture was more likely to be contaminated from the clean-catch urine specimen than from the straight catheter urine specimen (53.7% vs 23.1%). The positive and negative predictive values of leukocyte esterase on clean catch were 22.6% and 100%, respectively. Conclusions Diagnosing urinary tract infection based on contaminated urinalyses may lead to antibiotic overuse and misdiagnosis of postoperative complications. Our results can help educate health care partners and discourage the use of clean-catch urine specimens when assessing women who have recently undergone vaginal surgery.
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