Abstract:
OBJECTIVE:To analyze contemporary U.S. use of minimally invasive surgery for the treatment of endometrial cancer and associated inpatient complications and costs. METHODS:In this retrospective cohort study, the National Inpatient Sample database was analyzed in patients with nonmetastatic endometrial cancer who underwent hysterectomy during 2012-2013. Hierarchical multiple logistic regression and propensity score matching were used to compare complications among patients treated with open compared with minimally invasive hysterectomy surgery. Cost of care was also compared using generalized linear modeling. RESULTS:We identified 9,799 patients; 52.4% underwent open and 47.6% minimally invasive hysterectomy. Many patients (43.4%) were treated at low-volume hospitals (less than 10 endometrial cancer cases annually). Patients were less likely to undergo open surgery in high-volume compared with low-volume hospitals (51.8% compared with 58.1%, respectively; adjusted odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13-0.94) and more likely to undergo open surgery in rural compared with urban teaching hospitals (75.6% compared with 51.1%, respectively; adjusted OR 14.34, 95% CI 9.66-21.27), government compared with nonprofit hospitals (61.3% compared with 51.1%, respectively; adjusted OR 1.66, 95% CI 1.15-2.39), and in patients of black (67.9%; OR 1.46, 95% CI 1.30-1.65) and "other" race (60.5%; adjusted OR 2.39, 95% CI 1.99-2.87) compared with white race (49.2%, referent). Open surgery was associated with increased perioperative complications (adjusted OR 2.80, 95% CI 2.48-3.17) and a $1,243 increase in cost per case compared with minimally invasive approaches (P<.001). Using minimally invasive surgery for 80% of study patients may have averted 2,733 complications and saved approximately $19 million. CONCLUSION:Most U.S. women with endometrial cancer continue to be treated with open hysterectomy surgery despite increased complication rates and financial costs associated with this approach. A disparity in endometrial cancer surgical care exists that is affected by patient race and hospital geography and cancer volumes.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Mannschreck D,Matsuno RK,Moriarty JP,Borah BJ,Dowdy SC,Tanner EJ 3rd,Makary MA,Stone RL,Levinson KL,Temkin SM,Fader ANdoi
10.1097/AOG.0000000000001567subject
Has Abstractpub_date
2016-09-01 00:00:00pages
526-34issue
3eissn
0029-7844issn
1873-233Xjournal_volume
128pub_type
杂志文章abstract:OBJECTIVE:To determine the efficacy of oral rizatriptan 10 mg and 5 mg for treating menstrually associated migraine attacks. METHODS:Data from two large clinical trials with identical designs were included in a retrospective analysis. The studies were randomized, double-masked, placebo-controlled, incomplete block, tw...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(00)00880-2
更新日期:2000-08-01 00:00:00
abstract::The Acyclovir in Pregnancy Registry was established to gather data on prenatal exposure to acyclovir. Exposed pregnancies are tracked prospectively to ascertain exposure, risk factors, and pregnancy outcome. Through June 30, 1990, 312 acyclovir-exposed pregnancies had been reported and followed. Of these, 239 were exp...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:To estimate receipt of recommended gynecologic care, including cancer screening and menstrual care, among women with Down syndrome in the United States. METHODS:We conducted a retrospective cohort study of women participating in DS-Connect, the National Institute of Health's registry of women with Down syndr...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003997
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Endocardial fibroelastosis is a congenital heart disease known to cause congestive heart failure in early infancy. We report a case using new modalities for early prenatal diagnosis of endocardial fibroelastosis causing fetal heart failure. CASE:A multipara with two children, who died of endocardial fibroel...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(01)01505-8
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:To determine whether stage of disease and treatment patterns account for mortality differences between black and white women with cervical cancer. METHODS:Using data obtained from the Surveillance, Epidemiology, and End Results (SEER) Program for 1988-1994, we determined the associations between race and sta...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(99)00334-8
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:To estimate the incidence of methicillin-resistant Staphylococcus aureus (MRSA) among women with vulvar abscesses and to describe clinical factors associated with inpatient compared with outpatient treatment. METHODS:We reviewed all women with a vulvar abscess who were treated with incision and drainage betw...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181827829
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVE:To estimate normal ranges for postpartum maternal vital signs. METHODS:We conducted a multicenter prospective longitudinal cohort study in the United Kingdom. We recruited women before 20 weeks of gestation without significant comorbidities and with accurately dated singleton pregnancies. Women recorded thei...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000004239
更新日期:2021-02-01 00:00:00
abstract:OBJECTIVE:To study the relation between the timing of the postpartum examination and the postpartum Papanicolaou smear. METHODS:One hundred eighty-four women in labor at Arlington Community Hospital were randomized to receive their postpartum Papanicolaou smear at 4, 6, or 8 weeks after delivery. Samples from the exoc...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:To estimate, from the literature, when nonlactating postpartum women regain fertility. DATA SOURCES:We searched PubMed and Cochrane Library databases for all articles (in all languages) published in peer-reviewed journals from database inception through May 2010 for evidence related to the return of ovulati...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0b013e31820ce18c
更新日期:2011-03-01 00:00:00
abstract::Although the absence of pituitary response to the luteinizing hormone releasing hormone (LHRH) test has been considered proof of a lesion primarily localized at the pituitary level, the possibility exists that an absent pituitary response may represent only the effect of a chronic deficiency of hypothalamic secretion....
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1975-05-01 00:00:00
abstract::Karyotypes of chorionic villi have been said to be less accurate than karyotypes of amniocytes. Karyotypic differences between placental and fetal tissue and maternal-cell contamination could potentially complicate clinical management. We compared cytogenetic results obtained by chorionic villus sampling and amniotic ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:To determine whether glucagon has relaxant effects on the spontaneous contractions of term pregnant human uterine smooth muscle in an isolated preparation. METHODS:Myometrial specimens were excised from the upper incisional surface of the lower uterine segment in seven women during elective cesarean delivery...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(96)00283-9
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:Monoamniotic twin pregnancies are frequently associated with cord entanglement, but such entanglement rarely involves the co-twin's trunk, extremities, or neck. CASE:We report a set of monoamniotic twins in which color Doppler imaging revealed that the cord of twin B was wrapped around the neck of its dead ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:To compare sexual function in women with urinary incontinence and pelvic organ prolapse and to determine the effects of therapy on sexual function. METHODS:343 community-dwelling women older than 45 years with urinary incontinence or advanced prolapse were recruited into a multi-armed clinical trial. Women w...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0029-7844(01)01727-6
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVE:To estimate the clinical effectiveness, as determined by positive pregnancy test, of letrozole compared with clomiphene citrate for ovarian stimulation in patients with unexplained infertility. DATA SOURCES:We conducted a systematic review and meta-analysis of data from electronic databases including Ovid-ME...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1097/AOG.0000000000003105
更新日期:2019-03-01 00:00:00
abstract::Periodic assessments offer an excellent opportunity for obstetricians and gynecologists to provide preventive screening, evaluation, and counseling. The American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice recommends routine assessments in primary and preventive care for women based o...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0b013e318219226e
更新日期:2011-04-01 00:00:00
abstract::Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC)....
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/AOG.0000000000002398
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:To compare the effect of delivery on cerebral blood flow velocity between normotensive and preeclamptic women, adjusting for mode of delivery and change in hematocrit values. METHODS:Twenty-three normotensive and 46 preeclamptic women had maternal middle cerebral blood flow velocity assessed antepartum and a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1993-09-01 00:00:00
abstract::A 27-year-old, previously healthy normotensive woman was admitted for hyperemesis gravidarum and treated with intravenous fluids and metoclopramide. Thereafter, a neuropsychiatric syndrome developed, with acute asymmetrical axonal motor-sensory polyneuropathy and marked anxiety, depression, irritability, and memory an...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Spectral Doppler ultrasound, an important diagnostic tool for the functional assessment of various organs, as yet has no major use in prenatal diagnosis due to the conventional technique's limitation of analyzing only one site at a time. Our aim was to develop a new modality that shows simultaneous studies o...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:
更新日期:1998-08-01 00:00:00
abstract::Fifteen fallopian tubes in which a previous ipsilateral eccyesis was managed by conservative surgical techniques were examined. The condition of the tube relative to the previous surgical management and the resolution of the previous implantation sites were correlated with the recurrent tubal pregnancy. All previous i...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract::Although pneumonia complicating pregnancy remains an unusual occurrence, it can have serious consequences for both the mother and fetus. Although Streptococcus pneumoniae remains the most common bacterial pathogen, recent epidemics have emphasized the importance of considering Legionella pneumophila as the etiologic a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198603001-00003
更新日期:1986-03-01 00:00:00
abstract::Continuous tissue pH monitoring of the fetus was successfully conducted in 13 of 21 patients (61.9%) during labor. There was a significant correlation between the tissue pH and both the scalp capillary blood pH (r = 0.94, P less than 0.001) and the umbilical artery blood pH (r = 0.92, P less than 0.01). These findings...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1980-04-01 00:00:00
abstract::Several pharmacologic agents are known to interfere with urinary estriol levels in pregnancy. This report implicates erythromycin as yet another agent responsible for such interference. ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1980-09-01 00:00:00
abstract::A 10-year retrospective study of acute puerperal inversion of the uterus was undertaken at Women and Infants Hospital of Rhode Island. There were 11 inversions in 70,481 deliveries for an incidence of one in 6407. The age ranged from 19-31 years. Seventy-three percent occurred in nulliparous women. All cases were reco...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-04-01 00:00:00
abstract:BACKGROUND:Umbilical vascular coiling may function as a rudimentary pump that facilitates venous return from the placenta. CASES:Three consecutive twin gestations with twin-twin transfusion syndrome were evaluated prospectively at delivery. The birth weights and umbilical coiling indices of donor and recipient twins w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(97)00057-4
更新日期:1997-05-01 00:00:00
abstract::The CO2 laser has become a valuable tool for the treatment of lower genital tract neoplasia. The records of 52 women who underwent CO2 laser cervical conization were analyzed retrospectively to evaluate the effect of tissue thermal damage on histopathologic interpretation. Lesion evaluability, defined by the ability t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVE:To present our current understanding of oxytocin and its receptors during pregnancy and parturition and their potential clinical applications. DATA SOURCES:A MEDLINE search was conducted for pertinent articles from 1966 to October 1996 related to oxytocin and its receptor and their clinical implications duri...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0029-7844(97)00056-2
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To estimate the effectiveness of a behavioral educational intervention to reduce postpartum depressive symptoms among minority mothers. METHODS:We recruited 540 self-identified black and Latina mothers during their postpartum hospital stay and randomized them to receive a behavioral educational intervention ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/AOG.0b013e318250ba48
更新日期:2012-05-01 00:00:00
abstract::In a patient with Nelson's syndrome, elevated peripheral concentrations of androgens usually associated with neoplasm prompted ovarian vein catheterization. Androgen excess was limited to the right ovary. However, laparotomy revealed bilateral multiple paraovarian nodules with histologic appearance of adrenocortical t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00