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PubMed2006

ACOG Practice Bulletin No. 74. Antibiotic prophylaxis for gynecologic procedures.

Surgical site inflection remains the most common surgical complication. Up to 5% of operative patients will develop a surgical site infection leading to a longer hospital stay and increased cost. One of the advances in infection control practices has been the selective use of antibiotic prophylaxis. However,antibiotic use, especially prophylactic antibiotic use, has been associated with the selection of antibiotic-resistant bacteria. Indiscriminate use of prophylactic antibiotics for institutions as well as for individual patients promotes this dangerous side eject. There are acknowledged consequences of prophylactic antibiotic use for institutions as well as for individual patients. It is important for clinicians to understand when antibiotic prophylaxis is indicated and when it is inappropriate. The purpose of this document is to review the evidence for surgical site infection prevention and appropriate antibiotic prophylaxis for gynecologic procedures.

Abortion, Induced↗
PubMed2003

A study of the incidence and recognition of surgical glove perforation during obstetric and gynecological procedures.

OBJECTIVES: The purpose of this study was to compare the frequency of surgical glove perforation among obstetric and gynecological surgical procedures, and to evaluate surgeons' perceptions. MATERIALS AND METHODS: A cross-sectional study was conducted in which nursing personnel examined the gloves used in obstetric and gynecological procedures, immediately after the surgery, in order to detect perforations. RESULTS: Surgical glove perforation occurred in 20.8% of 817 obstetrics procedures and 24.4% of 131 gynecology procedures. The observed difference between groups was not statistically significant (p=0.35). Obstetricians perceived the occurrence of perforation in 30.6% of the events, and gynecologists in 37.5%. This difference was not statistically significant (p=0.44).

Brazil↗
PubMed2001

[Surgical procedure of gynecologic malignances in patients over 70 years].

OBJECTIVE: To assess the viability of performing surgical procedure on gynecologic malignances patients over 70 years old. METHODS: A retrospective study of all patients 70 years of age and older treated by surgical procedure for gynecologic malignances was performed between September 1, 1983, and June 30, 1999. RESULTS: Fifty-seven patients were older than 70 years of age at the time of the diagnosis. Mean age of the patients was 73.5 years. In thirty-four patients a extensive surgical procedure was carried out, while in twenty-three patients a conservative surgery was done. Seventy-one percent of patients had one or more preexisting medical illnesses. Minor surgical morbidity occurred in 31.6% of the patients, while major surgical morbidity occurred in 10.5% of the patients. There were no differences in the type of surgical procedure, mean hospital stay, preexisting medical illness and postoperative complication between patients 70 to 75 and over age 75. The total major postoperative complications occurred in extensive surgical procedure group and postoperative mean stay was also significantly length. CONCLUSIONS: The extensive surgical procedure is a safe treatment for elderly patients with gynecologic malignances. Careful preoperative assessment, monitoring, and meticulous postoperative care are vital to the success.

Aged↗
PubMed2004

ACOG committee opinion. Surgery and patient choice: the ethics of decision making. Number 289, November 2003.

The purpose of this Committee Opinion is to provide the obstetrician-gynecologist with an approach to decision making based on ethics in an environment of increased patient information, recognition of patient autonomy, direct-to-consumer marketing, and many alternative or investigational treatments. A process for ethical decision making in surgery is discussed, illustrated by an example of elective cesarean delivery.

Cesarean Section↗
PubMed2006

Preoperative surgical case review program in a community-based, academic medical center: a feasibility study.

OBJECTIVE: To assess the feasibility of applying postoperative objective criteria for preoperative evaluation of scheduled gynecologic cases. STUDY DESIGN: A preoperative evaluation program was introduced in which all surgeons were asked to voluntarily submit a 1-page case summary questionnaire for each elective gynecologic surgical procedure. A committee of departmental peers reviewed each submission for appropriateness of indications and completeness of preoperative evaluation. Cases were evaluated against quality assessment criteria sets created by the American College of Obstetricians and Gynecologists. Reviewed summaries were categorized as either meeting criteria, not meeting criteria but appropriate, not meeting criteria or no pertinent criteria available for the procedure planned. RESULTS: In all, 2,005 elective gynecologic surgical procedures were performed by 70 active surgeons during the 1-year study period; 1,166 procedures (58%) were reported. Of 70 surgeons, 57 reported at least 1 procedure, but only 6 were 100% compliant with their surgical submissions. In total, 1,008 procedures (86% of reported cases) met the criteria or were deemed appropriate by committee review. In 166 instances, additional information was requested from and provided by the surgeon before the case could be adjudicated. CONCLUSION: A voluntary program of preoperative surgical case review for scheduled gynecologic procedures appeared feasible but resulted in only modest initial participation.

Academic Medical Centers↗
PubMed2001

Reimbursement for surgical procedures in gynecologic oncology.

Reimbursement for gynecologic oncologists can be categorized into three areas: payments for evaluation and management of clinical diagnosis, payments for chemotherapy, and reimbursement for surgical procedures. Revenue from surgical care is generally considered the major source of income for gynecologic oncologists. The transition to Medicare's resource-based relative value scale-based physician payment system began on January 1, 1992, culminating nearly a decade of effort by the medical profession and the government to change the way Medicare pays for physician services. The resource-based relative value scale payment schedule was fully phased in on January 1, 1996, and has been adopted by other third party payers. As a result of this reform, relative value units were created for current procedural technology codes and represent a composite of work, practice, and malpractice expenditures. When multiplied by a dollar conversion factor, relative value units can be used to calculate the reimbursement amount for all procedures covered by Medicare and other private insurers. Many of the discrepancies in reimbursement for similar procedures performed by gynecologists and urologists were partially corrected in 1997; however, sex-specific bias still exists in payment for surgical procedures performed on men and women.

Diagnosis-Related Groups↗
PubMed1991

Outpatient gynecologic procedures.

The majority of gynecologic surgical procedures can be performed on an outpatient basis. Utilization of outpatient surgical centers helps reduce the cost of health care, lessens the disruption of patients' personal lives, and promotes their recovery through early ambulation and a lower incidence of postoperative nosocomial complications. Patient education and improvements in anesthetic and surgical techniques will allow additional and more complicated gynecologic procedures to be performed in outpatient surgical centers. In doing so, the surgeon must not increase the overall risk of the procedure or compromise the surgical technique in a way that may produce a result that is not as good or as durable as the same procedure performed on an inpatient basis.

Abortion, Induced↗
PubMed2006

Use of spinal anaesthesia in day surgery.

PURPOSE OF REVIEW: An increasing number of day-case surgical patients is challenging the presently used methods of anaesthesia: reliable surgical anaesthesia should be fast, with rapid recovery and minimal side effects. To compete with modern ambulatory general anaesthesia a knowledge of special spinal anaesthesia techniques is essential. This review brings together important issues concerning the spinal technique, anaesthetic agents and benefits as well as the disadvantages of spinal anaesthesia in outpatients. RECENT FINDINGS: For surgical procedures in one lower limb, a low dose of hyperbaric bupivacaine with standardized spinal anaesthesia technique produces a reliable block, with low incidence of side effects and home-readiness equal to spinal anaesthesia with lidocaine (50 mg) or general anaesthesia (desflurane), whereas ropivacaine has not shown benefits over spinal anaesthesia with bupivacaine. 'Walk-in, walk-out' spinals with an extremely low dose of lidocaine and opioids for gynaecological laparoscopy created the concept of selective spinal anaesthesia. Reintroduction of chloroprocaine may provide a solution for bilateral, short-acting spinal anaesthesia in the future. SUMMARY: To produce reliable spinal anaesthesia with a reasonable recovery time it is essential to understand the factors affecting the spread of spinal block and to choose the optimal drug and adequate dose for specific surgical procedures.

Ambulatory Surgical Procedures↗
PubMed2003

Equity in Canadian health care: does socioeconomic status affect waiting times for elective surgery?

BACKGROUND: Waiting times for surgical and other procedures are an important measure of how well the health care system responds to patient needs. In a universal health care system such as Canada's, it is important to determine if waiting times vary by socioeconomic status (SES). We compared waiting times for elective surgery of patients living in low and high socioeconomic areas. METHODS: We reviewed the medical charts of all patients who underwent elective surgery at a Canadian academic health centre between 1992 and 1999. Using patient postal codes we assigned SES on the basis of 5 characteristics in the 1996 census data. We compared waiting times for surgery for people from regions in the lowest third (low SES group) with that for patients from regions in the upper third (high SES group). RESULTS: On average, patients in the high SES group waited 31.1 days and those in the low SES group waited 29.3 days. When differences in waiting times for 22 common procedures were examined between the groups, only the difference for prostatectomy was statistically significant: patients in the high SES group waited 4.4 fewer days than those in the low SES group. INTERPRETATION: We found little evidence that residing in a region in which SES was in the lowest third was associated with longer waiting times for elective surgery.

Canada↗
PubMedDate not supplied

[Variability of intestinal preparation in patients undergoing stomach, intestine, uterus surgery at 4 hospitals].

The standard preoperative care of the surgical wards of 4 hospitals for patients undergoing abdominal (stomach and colon) and gynaecological (uterum) surgery has been described. Date collection included the comparative assessment of standard protocols and intervention, with nurses in charge of the preoperative care. Patients undergoing colon surgery may be prescribed an ash-free diet for 7-10 days or may eat normal meals till two days before the surgery. The same variability exists for the antimicrobial prophylaxis and its route of administration. Patients are not allowed to drink from the midnight before the surgery. Enemas administered the afternoon before the surgery may contain castor oil. A systematic review of preoperative care is warranted and guidelines for an evidence based practice should be provided in order to reduce the variability and improve the effectiveness of preoperative care.

Digestive System Surgical Procedures↗
PubMed1986

Major surgical procedures for gynecologic malignancy in elderly women.

We review 89 patients more than 75 years old who had major operations for various gynecologic malignancies. The recent routine use of perioperative intensive care decreased hospital mortality from 8.9% to 3.2%, and helped in decreasing and anticipating intraoperative and postoperative cardiorespiratory complications. Availability of visiting nurses since 1980 decreased the mean hospital stay from 30.2 to 24.4 days in patients who had radical vulvectomy. There were no deaths among 11 patients who subsequently had surgical reexploration for recurrent or new disease. Fifty-two of the 89 patients survived more than three years with no limitations resulting from the operations. When indicated, major surgical procedures for gynecologic malignancy in elderly women can be done safely, especially when the patient is evaluated and managed in a well staffed surgical intensive care unit.

Aged↗