Abstract:
BACKGROUND:Emerging research supports that fewer complications occur in patients who undergo surgery by higher surgical volume surgeons. The midurethral sling surgery has been involved in recent warnings and litigation, which further supports a need to understand features that enhance its safety and efficacy. OBJECTIVE:The purpose of this study was to measure the impact of a surgeon's volume on their patient's rate of reoperation after midurethral sling surgery. STUDY DESIGN:This was a retrospective cohort study that evaluated all surgeons who performed synthetic mesh midurethral sling surgery for stress urinary incontinence at a large managed care organization with >4.5 million members from 2005-2016. Physicians Current Procedural Terminology and International Classification of Diseases, version 9/10, codes were used to identify the procedures and the reoperations that were performed. The system-wide medical record was queried for demographic and perioperative data. The primary outcome was the overall reoperation rate after midurethral sling surgery. Concentration curves were used to identify the impact of a surgeon's surgical volume on their rate of reoperation. Demographics, characteristics, and reoperation of patients were compared with the use of chi-square test for categoric variables and Wilcoxon rank sum test for continuous variables. Poisson regression models with a robust error variance were used to calculate the unadjusted and the adjusted risk ratios of reoperation with the use of age, body mass index, marital status, race, parity, vaginal estrogen use, sling type, smoking, diabetes mellitus, and menopausal status as covariates. RESULTS:Two hundred twenty-seven surgeons performed 13,404 midurethral sling surgeries over the study period; patients had a mean of 4.4 years of follow up. Higher-volume surgeons (>40 procedures/year, ≥95th percentile) performed 47% of the surgeries in this cohort and had an overall lower rate of reoperation (3.6% vs 4.2%; 95% confidence interval, 0.67-0.94; P=.04) compared with lower-volume surgeons. Higher-volume surgeons had a lower rate of reoperation for surgical failure (2.7% vs 3.6%; 95% confidence interval, 0.55-0.92; P<.01). Rates of reoperation for complications were similar between the 2 groups (1.1% vs 0.9%; 95% confidence interval, 0.82-1.13; P=.32). For patients whose condition required a reoperation secondary to complication, the rates of reoperation for urinary retention (0.9% vs 0.6%; P=.06), mesh exposure (0.2% vs 0.3%; P=.31), hemorrhage/bleeding (0.1% vs 0.0%; P=.11), pain (0.1% vs 0.1%; P=.52), and infection (0.0% vs 0.0%; P=.37) did not differ between higher- and lower-volume surgeons. The risk ratio for reoperation that compared higher- and lower-volume surgeons was 0.83 (95% confidence interval, 0.67-0.98; P=.01) in the adjusted model. CONCLUSION:Although the reoperation rates were low for both higher- and lower-volume surgeons, higher-volume surgeons had lower overall rates of reoperation after midurethral sling surgery. This effect is seen most dramatically in reoperation for surgical failure, in which patients who have surgery with a higher-volume surgeon are 25% less likely to have postoperative stress urinary incontinence that leads to reoperation.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Berger AA,Tan-Kim J,Menefee SAdoi
10.1016/j.ajog.2019.09.006subject
Has Abstractpub_date
2019-11-01 00:00:00pages
523.e1-523.e8issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(19)31111-1journal_volume
221pub_type
杂志文章abstract::Low maternal serum alpha-fetoprotein values during the second trimester of pregnancy are associated with an increased risk of Down syndrome in the fetus. In this study a sensitive, monoclonal-based radioimmunoassay for alpha-fetoprotein was used to determine whether such an association also applies to the first trimes...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90449-8
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated. STUDY DESIGN:Thirty patients were randomly divided among a study populat...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(93)90134-5
更新日期:1993-07-01 00:00:00
abstract::Cystine animopeptidase (CAP) and leucine aminopeptidase (LAP) in choriocarcinoma cells grown in culture were assayed and characterized electrophoretically. The specific activity of CAP in choriocarcinoma was about 1.5-fold greater than the specific activity of term placenta. The extract of choriocarcinoma contained an...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(75)90574-8
更新日期:1975-07-15 00:00:00
abstract::Virilization in pregnancy has been reported with various ovarian neoplasms. Presented is a case of maternal virilization resulting from an unclassified sex-cord stromal neoplasm. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90627-1
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVES:The purposes of this study were (1) to determine 24-hour urinary protein excretion rates in normal human pregnancy and (2) to assess the reliability of assessment of proteinuria by dipstick measurement. STUDY DESIGN:At 17 to 20 and 33 to 36 weeks of pregnancy, 174 normal volunteers collected a 24-hour urine...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)91578-6
更新日期:1992-09-01 00:00:00
abstract:BACKGROUND:Abruptio placentae is a complex multifactorial disease that is associated with maternal and neonatal death and morbidity. Abruptio placentae's high recurrence rate, high prevalence of heritable thrombophilia among women with abruptio placentae, and aggregation of cases in families of women with the disease s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.08.042
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:We sought to develop a valid, reliable assessment of intraoperative judgment by residents during gynecologic surgery based on Script Concordance Theory. STUDY DESIGN:This was a multicenter prospective study involving 5 obstetrics and gynecology residency programs. Surgeons from each site generated case scena...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2010.04.010
更新日期:2010-09-01 00:00:00
abstract::Significant public health disparities exist surrounding teen and unplanned pregnancy in the United States. Women of color and those with lower education and socioeconomic status are at much greater risk of unplanned pregnancy and the resulting adverse outcomes. Unplanned pregnancies reduce educational and career oppor...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2016.02.017
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to investigate the impact of postpartum fecal incontinence (FI) and urinary incontinence (UI) on quality of life (QOL). STUDY DESIGN:Seven hundred fifty-nine primiparous women in the Childbirth and Pelvic Symptoms study were interviewed 6 months postpartum. FI and UI were asses...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.08.020
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:Our purpose was to define the diagnostic value of a new fetal assessment score that is based on each of the components of the Apgar score. STUDY DESIGN:A fetal assessment score was established to study the main fetal vital functions: (1) cardiovascular (heart rate, color of the skin in the Apgar score), now ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90618-s
更新日期:1993-09-01 00:00:00
abstract::The plasma fibronectin concentration was abnormally elevated (greater than 400 micrograms/ml) in 16 of 17 normotensive gravid women who subsequently developed preeclampsia. Of this group, 13 had elevated levels detectable greater than or equal to 4 weeks before the onset of hypertension. Our results indicate that plas...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90748-9
更新日期:1986-05-01 00:00:00
abstract::It is demonstrated that for rats N,N'-bis(dischloroacetyl)-1,8-octamethylenediamine (Win 18,446) is a highly efficient embryocidal N,N'-bis(dichloroacetyl)-1,8-octamethylenediamine It was previously used to supress spermatogenesis in man and other mammals. In the initial rat studies, a fixed dosage of Win 18,446 was...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(74)90117-3
更新日期:1974-07-01 00:00:00
abstract::Spontaneous preterm birth is a heterogeneous phenotype. A multitude of pathophysiologic pathways culminate in the final common denominator of cervical softening, shortening, and dilation that leads to preterm birth. A precise description of specific microstructural changes to the cervix is imperative if we are to iden...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2012.05.015
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:After initiating a new contraceptive method, the provider has little control of how or whether that method is used. OBJECTIVE:We sought to compare unintended pregnancy rates by the initial chosen contraceptive method after counseling to traditional contraceptive effectiveness in the same study population. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.01.162
更新日期:2016-07-01 00:00:00
abstract::The therapeutic effect of magnesium sulfate remains unknown. Its role as an anticonvulsant is controversial. The effect of pretreatment with parenteral magnesium sulfate on the ability to initiate penicillin-induced seizure foci in anesthetized cats was studied. All animals in the experimental group achieved serum mag...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90482-1
更新日期:1989-02-01 00:00:00
abstract:BACKGROUND:Epithelial ovarian cancer prognosis is improved by the presence of intratumoral CD3 + T cells, which are known to produce interferon-gamma. We therefore speculated that interferon-gamma expression in ovarian cancer-infiltrating T-lymphocytes might cause better prognosis. PATIENTS AND METHODS:Reverse transcr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.05.007
更新日期:2004-11-01 00:00:00
abstract::A descriptive study of 125 infants with abdominal wall defects was undertaken to determine the effect of mode of delivery on outcome. Fifty-six infants had gastroschisis and 69 had omphalocele. Overall, there were no differences between the omphalocele and the gastroschisis groups in either cesarean section rate (22% ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91079-r
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVES:Our objectives were to document the causes of fluid absorption during continuous flow hysteroscopy and to determine under which operative conditions fluid overload may occur. STUDY DESIGN:Fifteen patients underwent operative hysteroscopy with 2% ethanol solution for uterine distention. Absorption of fluid w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)91417-3
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine whether the biguanide oral antihyperglycemic agent metformin increases human placental uptake and transport of glucose to the fetal circulation. STUDY DESIGN:The human single-cotyledon model was used to compare transport of tritiated glucose in the maternal to fetal direction in ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70541-6
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:Our objective was to study the effect of estrogen administration and moderate hypertension on left ventricular size, pump function, and contractility in chronically instrumented ewes. STUDY DESIGN:Ewes were either given 0.06 mg/kg 17beta-estradiol intramuscularly (n = 8) or were made hypertensive (n = 6) by ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70053-5
更新日期:1998-09-01 00:00:00
abstract::Clostridium sordellii is a common soil and enteric bacterium that is infrequently recovered from the vagina. We describe three women in which C. sordellii caused puerperal infection and a distinctive and lethal toxic shock-like syndrome. Patients were less than 1 week post partum and each had a single, limited focus o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90768-0
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVES:Our goals were (1) to determine whether hypertension, proteinuria, and glomerular endotheliosis can be produced by chronic reduction of lower aortic pressure in pregnant rhesus monkeys and (2) to study the time course of the development of hypertension by means of longitudinal arterial blood pressure measure...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90171-e
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVE:We used the Danish National Birth Cohort to estimate the effect of shift work on the duration of pregnancy and birth weight. STUDY DESIGN:In the Danish National Birth Cohort (1998-2001), we identified women (and their singleton births): 32465 women with daytime work, 1038 women with fixed evening work, 400 w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2003.12.002
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVES:Preeclampsia is associated with hypertension, fetal growth retardation, and proteinuria. We hypothesized that impaired vascular nitric oxide synthesis during pregnancy may be an important causal factor in preeclampsia. STUDY DESIGN:An inhibitor of nitric oxide synthase, L-nitro-arginine methyl ester, or a n...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90299-x
更新日期:1993-11-01 00:00:00
abstract::With basic methodologic criteria as a framework, this report assesses the quality of the seven randomized controlled clinical trials conducted in five countries to compare a policy of routine electronic fetal monitoring with a policy of fetal heart rate monitoring by auscultation. One trial found a statistically signi...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(87)90197-9
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVE:Our purpose was to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at operative vaginal delivery. STUDY DESIGN:We obtained data from 2041 consecutive operative vaginal deliveries and compared yearly rates of episiotomy, lacerations, and potential confounders w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70507-6
更新日期:1997-02-01 00:00:00
abstract::The mechanisms of steroid action remain a poorly understood enigma. Although much effort has focused on the steroid receptor as a mediator of the steroid's effect in the cell, we are only beginning to understand the structure of steroid receptors. Development of monoclonal antibodies directed against both the steroid-...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90015-9
更新日期:1987-06-01 00:00:00
abstract:OBJECTIVE:Polymorphic variants of the human progesterone receptor gene have been described, but their potential influence on in vitro fertilization outcome have not been studied. STUDY DESIGN:DNA was available from 317 women (cases) who had >or=2 embryo transfers without a clinical pregnancy and from 288 women (contro...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/s0002-9378(03)00517-9
更新日期:2003-10-01 00:00:00
abstract::Progeny of women, whose thyroid function was studied gestationally, had psychological and/or neurologic examinations at 8 months, 4 years and 7 years of age. In more than 100 pregnancies (at least 3 per cent of total pregnancies) hypothyroxinemia occurred and was treated adequately or inadequately. Children were deliv...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-08-01 00:00:00
abstract::Severe obstructive sleep apnea, a disturbance of sleep resulting from intermittent periodic obstruction of the upper airway, was diagnosed after cardiotocography during which the external tocodynamometer disclosed a pattern initially thought to represent uterine activity. In spite of this obstructive sleep apnea with ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90354-t
更新日期:1991-11-01 00:00:00