Abstract:
BACKGROUND:Venous thromboembolism events, including deep venous thrombosis and pulmonary embolism are the most common cause of preventable deaths in hospitalized patients in the United States. Although the risk of venous thromboembolism events in benign gynecologic surgery is generally low, the potential for venous thromboembolism events in urogynecologic population is significant because most patients undergoing the pelvic organ prolapse surgery have increased surgical risk factors. OBJECTIVE:This study aimed to investigate the incidence and risk factors for venous thromboembolism events within 30 days after different routes of the pelvic organ prolapse surgery in a large cohort population using the American College of Surgeons-National Surgical Quality Improvement Program. STUDY DESIGN:This retrospective cohort study used Current Procedural Terminology codes to identify pelvic organ prolapse repairs with and without concurrent hysterectomy performed during 2011-2017 in the American College of Surgeons-National Surgical Quality Improvement Program database. Demographics, preoperative length of hospital stay, operative time, preoperative comorbidities, smoking status, American Society of Anesthesiologists classification system scores, along with other variables were collected. Postoperative 30-day complications, including readmission, reoperation, and mortality, were collected. The incidence rates of venous thromboembolism, as defined by American College of Surgeons-National Surgical Quality Improvement Program, were compared among different surgical routes. Descriptive statistics were used, and logistic regression was performed to identify associations. RESULTS:Among 91,480 pelvic organ prolapse surgeries identified, 63,108 were analyzed: 43,279 (68.6%) were performed vaginally, 16,518 (26.2%) laparoscopically, and 3311 (5.2%) abdominally. A total of 34,698 (55.0%) underwent a concurrent hysterectomy. Of 63,108 subjects, 133 developed venous thromboembolism within 30 days after surgery (0.21%; 95% confidence interval, 0.18-0.25; P<.0001). More than half (60%) of venous thromboembolism events occurred within 10 days after surgery. For all surgical routes, older age (P<.041), higher body mass index (P=.002), race or ethnicity (P=.04), longer operating time (P<.0001), inpatient status (P<.0001), American Society of Anesthesiologists 3 or 4 (P<.0001), having preoperative renal failure (P=.001), and chronic steroid use (P=.02) were significantly associated with venous thromboembolism. In addition, in the vaginal pelvic organ prolapse repair group, concurrent hysterectomy (P=.03) and preoperative dyspnea (P=.01) were associated with development of venous thromboembolism. In the abdominal pelvic organ prolapse repair, concurrent hysterectomy (P=.005) and hypertension requiring medication (P=.04) were also independently associated with venous thromboembolism development (Table 1). The incidence of venous thromboembolism was highest in abdominal repairs (0.72%), followed by laparoscopic repairs (0.25%) and vaginal repairs (0.16%). After adjusting for confounders, abdominal compared with vaginal approach (adjusted odds ratio, 3.27; 95% confidence interval, 1.93-5.41; P<.0001), longer operative time (adjusted odds ratio, 1.005; 95% confidence interval, 1.003-1.006; P<.0001), older age (adjusted odds ratio, 1.020; 95% confidence interval, 1.00-1.037; P=.015), greater body mass index (adjusted odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P=.0006), American Society of Anesthesiologists 3 or 4 (adjusted odds ratio, 1.55; 95% confidence interval, 1.03-2.31; P=.03), and preoperative renal failure (adjusted odds ratio, 8.87; 95% confidence interval, 1.16-44.15; P=.04) remained significantly associated with developing venous thromboembolism. Neither laparoscopic repair (compared with vaginal repair) nor concurrent procedures (hysterectomy, antiincontinence procedure, vaginal mesh insertion) were found to be significantly associated with the development of venous thromboembolism. The abdominal pelvic organ prolapse repairs were associated with an increased hazard of venous thromboembolism (hazard ratio, 3.27; 95% confidence interval, 1.96-5.45; P<.0001). Venous thromboembolism development was associated with 30-day mortality, readmission, and reoperation (all P<.0001). CONCLUSION:The overall incidence of venous thromboembolism after pelvic organ prolapse repairs based on a recent, large cohort database was very low, confirming the finding in previous smaller cohort studies. The highest venous thromboembolism risk was associated with abdominal route, and more than 60% of venous thromboembolism events occurred within 10 days after surgery. Thus, focus should be placed on risk-reducing strategies in the immediate postoperative period, with greater emphasis on patients undergoing abdominal surgery.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Chong W,Bui AH,Menhaji Kdoi
10.1016/j.ajog.2020.05.020subject
Has Abstractpub_date
2020-08-01 00:00:00pages
268.e1-268.e26issue
2eissn
0002-9378issn
1097-6868pii
S0002-9378(20)30546-9journal_volume
223pub_type
杂志文章abstract:OBJECTIVES:The purpose of our study was to discover whether the testicular determining factor gene SRY (sex-determining region on Y) is present or absent in XX true hermaphrodites and in subjects with gonadal dysgenesis caused by Y aneuploidy. STUDY DESIGN:We screened five XX true hermaphrodites and 24 subjects with g...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91777-8
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:There is growing interest in uterine conservation at the time of surgery for uterovaginal prolapse, but limited data compare different types of hysteropexy. OBJECTIVE:We sought to compare 1-year efficacy and safety of laparoscopic sacral hysteropexy and vaginal mesh hysteropexy. STUDY DESIGN:This multicent...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.08.035
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine whether the combination of maternal serum alpha-fetoprotein, free human chorionic gonadotropin-beta, dimeric inhibin A, and maternal age detects aneuploidies other than Down syndrome. STUDY DESIGN:We retrieved stored serum from pregnancies complicated by aneuploidies other than D...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70198-x
更新日期:1998-10-01 00:00:00
abstract::Candidal vaginitis most often recurs during pregnancy and in the late luteal phase just before menstruation. We examined the influence of the stage of the menstrual cycle on the cellular immune response to Candida albicans, the efficiency of C. albicans germination in sera, and the ability of products from activated l...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90649-2
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:A select group of Escherichia coli strains known as uropathogenic cause pyelonephritis in nonpregnant individuals. We investigated whether Escherichia coli from gestational pyelonephritis represent a random population or possess common uropathogenic characteristics. STUDY DESIGN:Repetitive element sequence-b...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70337-x
更新日期:1996-03-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to measure fetal renal volume by means of three-dimensional ultrasonography and to use those data to establish the accurate constant and formula for fetal renal volume assessment with two-dimensional ultrasonography. STUDY DESIGN:Singleton fetuses between 15 and 40 weeks' gestation ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(00)70227-4
更新日期:2000-02-01 00:00:00
abstract::We used the minimal model technique to obtain concurrent measurements of whole-body insulin sensitivity and pancreatic B-cell responsiveness to glucose during the third trimester of pregnancy. Insulin sensitivity in normal pregnant women (n = 8) was reduced to only one third that of a group of nonpregnant women (n = 7...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91306-w
更新日期:1990-04-01 00:00:00
abstract::A national sample of 1944 white menopausal women greater than or equal to 55 years old from the epidemiologic follow-up of participants in the National Health and Nutrition Examination Survey was reviewed to investigate the role of hormone therapy in altering the risk of death from cardiovascular disease. Women in the...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)80006-2
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVE:We sought to describe the peripartum outcome of women weighing >300 pounds (135 kg) who were candidates for trial of labor after a prior cesarean delivery. STUDY DESIGN:All pregnant women who weighed in excess of 300 pounds and had a prior cesarean delivery were included in this prospective investigation. St...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.116729
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to assess the differential diagnostic potential of a combination of CA 125, CA 15-3, and CA 72-4 antigens in the definition of malignant disease, especially ovarian carcinoma in patients with a pelvic mass. STUDY DESIGN:A total of 412 patients were evaluated in a multicenter, re...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1067/mob.2002.123768
更新日期:2002-08-01 00:00:00
abstract::Leiomyomas most frequently occur in the genitourinary and gastrointestinal system. This report discusses clinical and pathologic findings of 2 leiomyomas in the pubovesical space, a location that has not been described before. Different operative approaches were used for excision. Immunohistochemical examination for t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.114503
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate temporal correlations between maternal serum placenta growth factor levels and placental perfusion in early human pregnancies. STUDY DESIGN:Systolic umbilical artery Doppler blood flow velocity indices at fetal and placental insertion sites were measured between 7...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.01.012
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the inhibitory effects of anti-interleukin-1beta and transforming growth factor-beta2 on the production of interleukin-1beta and prostaglandin E2 by human decidual cells. STUDY DESIGN:Decidual membranes were obtained from 30 patients between 37 and 40 weeks' gestati...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9378(98)70265-0
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. STUDY DESIGN:We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.01.099
更新日期:2006-07-01 00:00:00
abstract::We present a case of a primiparous patient at 35 weeks' gestation who had had laparoscopic gastric banding, and who presented to labor and delivery with protracted vomiting followed by an acute abdomen and fetal distress. An emergency surgery revealed acute gastric ulcer perforation. This complication, although rare, ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.03.036
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:Pertussis causes significant morbidity among adults, children, and especially infants. Since 2006, pertussis vaccination has been recommended for women after delivery. We conducted a prospective, controlled evaluation of in-hospital postpartum pertussis vaccination of birth mothers from October 2009 through J...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.09.043
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:Excess decidual macrophage infiltration has been linked to preeclampsia and a failure of endovascular trophoblast invasion. Severe preeclampsia with shallow placentation has also been linked to acquired and inherited maternal thrombophilias and recurrent decidual hemorrhage, which generates thrombin from deci...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.09.008
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVE:This study was designed to evaluate the uterine vascular responses to endothelin-1 in pregnant and estrogen-treated nonpregnant sheep. STUDY DESIGN:Seven pregnant and five nonpregnant oophorectomized ewes received local uterine artery infusions of endothelin-1, norepinephrine, and phenylephrine. Arterial blo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91755-y
更新日期:1992-12-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to determine whether the neonatal benefit of a single complete course of antenatal corticosteroids diminishes when delivery is remote from administration (> 14 days). STUDY DESIGN:This retrospective 2 center cohort trial included women who received a single complete course of antena...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2006.12.018
更新日期:2007-05-01 00:00:00
abstract::Twenty-six pregnant women were given prophylactic heparin treatment because of previous thromboembolic complications. The mean duration of treatment was 25 weeks (range, 6 to 32 weeks). The amount of heparin was adjusted to a plasma concentration of 0.08 to 0.15 IU/ml, measured as anti-factor Xa activity. This effect ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90535-8
更新日期:1989-08-01 00:00:00
abstract:OBJECTIVE:Intraperitoneal adhesions are a significant cause of morbidity among women of reproductive age. Monocyte chemotactic protein 1 plays a role in the chemotaxis of mononuclear cells and fibroblasts into the peritoneal injury site. To evaluate its role in intraperitoneal adhesion formation, we used an established...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70376-x
更新日期:1998-08-01 00:00:00
abstract::This study examined the effects of human chorionic gonadotropin, adrenocorticotropin, human luteinizing hormone, and mouse epidermal growth factor on growth (thymidine incorporation) and steroidogenesis (dehydroepiandrosterone sulfate production) of human fetal zone adrenal cells in monolayer culture. Two preparations...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90077-9
更新日期:1987-03-01 00:00:00
abstract::Ultrasonographic visualization of an enlarged cisterna magna was the initial clue that led to the prenatal diagnosis of trisomy 18 in five patients. Prenatal diagnosis of trisomy 18, a lethal defect, is important for proper patient counseling and management. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90238-x
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insulin injections (group 2, n = 24), or were already using an insulin pump before pregnancy (group ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.106182
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:Family planning is recommended as a strategy to prevent adverse birth outcomes. The potential contribution of postpartum contraceptive coverage to reducing rates of preterm birth is unknown. In this study, we examine the impact of contraceptive coverage and use within 18 months of a birth on preventing preter...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.07.033
更新日期:2015-11-01 00:00:00
abstract::The aim of this study was to observe the sequential effects of oxygenation, umbilical cord occlusion, and finally cooling on circulating catecholamines and nonshivering thermogenesis in fetal sheep. We studied five fetal sheep at 132 +/- 3 days' gestation. The fetuses were first ventilated with oxygen; PaO2 levels wer...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90655-b
更新日期:1991-01-01 00:00:00
abstract::As part of a multicenter prospective study, second-trimester human chorionic gonadotropin and alpha-fetoprotein concentrations were evaluated. Data included maternal age, human chorionic gonadotropin level, alpha-fetoprotein level, weight, race, and pregnancy outcome of 3428 pregnancies at between 15 and 20 weeks' ges...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90305-b
更新日期:1991-09-01 00:00:00
abstract::We analyzed changes over time in neonatal mortality rates for infants born weighing 501 to 1000 gm. The decline in total mortality in this weight group due to improved small-group, birth weight-specific mortality was contrasted to the increase in mortality caused by changes in the birth weight distribution resulting f...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90148-6
更新日期:1985-03-01 00:00:00
abstract::We studied whether plasma membranes from normal human placentas contain receptors for atrial natriuretic peptide. We identified specific, high-affinity, low-capacity atrial natriuretic peptide binding sites in the nonbrush border, microsomal fraction presumed to originate from cellular membranes near the fetal circula...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(88)80014-0
更新日期:1988-09-01 00:00:00
abstract::Amniotic fluid creatinine, percentage of lipid-positive cells, and L/S ratio were determined on 285 samples from normal pregnancies and 222 samples from abnormal pregnancy states (Rh isoimmunization, diabetes, hypertensive disorders, intrauterine growth retardation, and hydramnios). In normal pregnancy the coefficient...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90777-8
更新日期:1976-07-01 00:00:00