Obstetrics and Gynecology

Characteristics Predictive of Ovarian Cyst Resolution Based on Cyst Type, Size, Hormone Replacement Therapy Use, Menopausal Status, and Age Lindsay Bryant, Edward J Pavlik, PhD University of Kentucky College of Medicine, Lexington, KY Introduction: We assessed incident ovarian cyst resolution relative to ultrasonographic changes, aiding decisions on surveillance or operation. It impacts gynecologists, radiologists, surgeons, and oncologists by distinguishing benign from concerning abnormalities. Evaluating cyst structure, volume, age, menopausal status, and BMI informs surveillance or operative intervention, potentially reducing healthcare cost. Methods: In the UK Ovarian Cancer Screening Trial, 2,638 women with incident cysts underwent 51,356 transvaginal ultrasound (TVUS) examinations. Cases with operations affecting cyst resolution determination and those with solid structure or papillary projections were excluded. Analysis of 2,424 resolved cyst cases included dimensions, volume, age, BMI, family history, and hormone therapy, evaluated using Kaplan-Meier analysis. Results: The resolution time for ovarian cyst varied based on volume, age, menopausal status, hormone therapy, and cyst structure. Smaller cysts (0-20 cm³) resolved faster (1.92 years ± 0.06) than very large cysts (>100 cm³) (3.8 years ± 0.97). Age influenced resolution, with individuals aged 70 years and older resolving faster (1.80 years ± 0.17) than those aged 40 and younger (2.84 years ± 0.19). Premenopausal women took slightly longer to resolve (2.27 years ± 0.06) than postmenopausal women (2.37 years ± 0.11). Hormone therapy prolonged resolution (3.04 ± 0.15) compared with non-users (2.14 ± 0.05). Septated cysts resolved faster (1.85 ± 0.08) than unilocular cysts (2.55 ± 0.07). BMI and family history of ovarian cancer did not affect resolution. Univariate analysis showed significant association between resolution and cyst structure, volume, hormone therapy, and age (Figure 1).Figure 1Conclusion: Cyst resolution time is increased with volume, unilocular, younger age, and non-hormone replacement therapy use. Complication Associated with Inpatient Brachytherapy for the Treatment of Gynecologic Malignancy Brett Wright, MD, Kaitlyn Kincaid, MD, Olivia W Ricks, BS, Charles A Leath III, MD, MSPH, FACS, Samuel Marcrom, MD, Teresa W Boitano, MD, John M Straughn, MD University of Alabama at Birmingham, Birmingham, AL Introduction: The aim of this study was to determine risk factors for complication in gynecologic oncology patients receiving inpatient brachytherapy. Methods: This retrospective cohort study included gynecologic oncology patients receiving inpatient brachytherapy from 1/2019 to 12/2021 at an academic institution. Demographics, disease status, and radiation characteristics were collected. Thirty-day acute complications included: infection, venous thromboembolism (VTE), cardiac issues, cerebral vascular accident, hemorrhage, neuropathy, and ICU admission. Length of stay (LOS), 30-day readmission, and 30-day mortality were calculated. Statistical analysis was performed using SPSSv.28. Results: A total of 165 patients underwent inpatient brachytherapy. The most common applications were Syed needles (61.2%) and Kelowna (23.0%) devices. Most patients (68.5%) had cervical cancer and received an epidural (86.1%) for pain control. The overall complication rate was 17.0%; infection (46.7%), transfusion (20.0%), and neuropathy (13.3%) were most common. Patients who had ≥20 needles had a complication rate of 33.3% and an infection rate of 18.2%. On multivariate analysis, patients with complication were more likely to have a higher performance status (p = 0.02), chronic kidney disease (CKD) (p = 0.01), smoke (p = 0.02), and have >20 needles (p < 0.01). Patients who had complication experienced a longer LOS (4.4 vs 3.4 days, p < 0.01) and higher 30-day readmission rate (28.6% vs 4.4%, p < 0.01) (Table 1). Table 1. - Patients with No Complication vs Complication (n = 165) Variable No complication (n = 137) Complication (n = 28) Univariate p value Multivariate p value Age (y) 55.2 ± 12.7 54.6 ± 13.9 0.83 0.90 Race: Black, White, Latinx, Other 31 (22.6), 96 (70.1), 2 (1.5), 8 (5.8) 5 (17.9), 22 (78.6), 0 (0.0), 1 (3.5) 0.78 0.70 Performance Status: 0-1, 2-4 133 (97.1), 4 (2.9) 25 (89.3), 3 (10.7) 0.06 0.02* CKD 9 (6.6) 5 (17.9) 0.05 0.01* Smoker 35 (25.5) 13 (46.4) 0.03* 0.02* >20 Needles 22 (16.1) 11 (39.3) <0.01* <0.01* ICU Admission 0 (0) 2 (7.1) <0.01* 0.99 Length of Stay (days) 3.4 ± 0.6 4.4 ± 1.7 <0.01* <0.01* 30-day Readmission 6 (4.4) 8 (28.6) <0.01* <0.01* Conclusion: Patients undergoing inpatient brachytherapy are at risk for infection and vaginal bleeding. Risk factors included a performance status of 2-4, CKD, smoking, and ≥20 needles. We recommend creating a care bundle that includes labs, incentive spirometry, smoking cessation, VTE prophylaxis, and the administration of prophylactic antibiotics before inpatient brachytherapy. Factors Associated with 30-Day Mortality in Gynecologic Oncology Patients Admitted to the ICU Postoperatively Peter W Ketch, MD, McKenzie Foxall, BS, Kaitlyn Kincaid, MD, Andie M Grimm, BS, MPH, Elizabeth T Evans, MD, Michael D Toboni, MD, MPH, Charles A Leath III, MD, MSPH, FACS, John M Straughn, MD, Teresa K Boitano, MD The University of Alabama at Birmingham, Birmingham, AL Introduction: This study aimed to identify risk factors and outcomes of gynecologic oncology patients admitted to the ICU postoperatively. Methods: This retrospective cohort study included gynecologic oncology patients at a tertiary care center between 1/1/2019 and 12/1/2023. Patient demographics (age, race, BMI, performance status (PS), Charlson Comorbidity Index (CCI)) and operative factors (anesthesia and operative times, estimated blood loss (EBL), and intraoperative transfusion) were abstracted. Rates of operating room [OR]-to-ICU transfer, transfer on vasopressors and/or intubated, and reoperation were reviewed. ICU and hospital length of stay (LOS), 30-day readmission, and mortality rate were calculated. Statistics were performed using SPSS v28. Results: A total of 102 patients were identified, with an average age of 54.5 years (y). 54.9% were White, and 60.8% had a malignant diagnosis. Average EBL was 1181 cc, 50.0% of patients required intraoperative transfusion, and average ICU LOS was 3.9 days. Patients with a higher CCI (≥6), age ≥65 y, and those with malignancy had a higher rate of 30-day mortality compared with those with lower CCI, age <65 y, and benign disease (20.5% vs 3.4%, p < 0.001; 24.1% vs 4.5%, p < 0.01; 16.1% vs 2.5%; p = 0.03, respectively) (Table 1). Overall 30-day readmission rate was 16.7% and 30-day mortality rate was 10.8%. Table 1. - Factors Associated with 30-Day Mortality after ICU Admission Factor 30-d mortality p Value CCI <6 2 (3.4%) <0.001 CCI ≥6 9 (20.5%) <65 y 3 (4.5%) 0.03 ≥65 y 7 (24.1%) Benign diagnosis 1 (2.5%) <0.01 Malignant diagnosis 10 (16.1%) OR-ICU transfer 6 (8.7%) 0.33 Floor-ICU transfer 5 (15.2%) Conclusion: ICU admission is relatively uncommon in gynecologic oncology patients. Malignancy, complicated surgical procedures, and high intraoperative EBL may necessitate ICU admission. Patients at higher risk of 30-day mortality after ICU admission included CCI ≥6, age ≥65 y, and malignant disease. Close monitoring and further evaluation of modifiable risk factors is warranted in these patients to improve outcomes. How Well Are We Preserving Ovaries in Children and Adolescents? Analysis of NSQIP-Pediatric Data Humza Thobani, MBBS, Saleem Islam, MBBS, FACS, Faraz A Khan, MBBS, FACS Stanford University, Stanford, CA; Aga Khan University, Karachi, Pakistan Introduction: Pediatric ovarian lesions often necessitate surgical exploration to exclude malignancy. Ovarian preservation procedures (OP) allow conservation of ovarian parenchyma, however, carry a risk of residual malignancy. We aimed to compare OP use for benign and malignant lesions between pediatric surgeons and gynecologists. Methods: We queried the NSQIP-Pediatric database for children with either benign or malignant ovarian tumor who underwent OP or total oophorectomy. OP use was compared between pediatric surgery and gynecology after adjusting for tumor type, age, and covariates. The number of benign ovaries preserved which resulted in 1 malignant tumor missed - ie the number needed to harm (NNH) - was calculated for both pediatric surgery and gynecology. Results: Out of 2085 included patients (median age: 14.26 years), Pediatric surgeons managed the majority (72.4%, n = 1508), followed by gynecologists (25.2%, n = 526). Pediatric surgeons did not preserve 686 (51.7%) ovaries found to be benign on postoperative histopathology, compared with 146 (30.2%) for gynecology (Table 1). Upon adjusting for age and emergency presentation, pediatric surgeons were still less likely to perform OP for benign lesions (adjusted odds ratio [aOR] = 0.459, 95% CI = 0.364-0.578) than their gynecology counterparts. The NNH was similar for both specialties: 5.6 for pediatric surgeons and 5.3 for gynecologists. Table 1. - Use of Ovarian Preservation by Pediatric Surgeons and Gynecologists Tumor Type Primary team Ovarian preservation; n (%) No ovarian preservation; n (%) p Value Overall Pediatric Surgery 654 (43.4) 854 (56.6) <0.001 Gynecology 343 (65.2) 183 (34.8) Benign Pediatric Surgery 642 (48.3) 686 (51.7) <0.001 Gynecology 337 (69.8) 146 (30.2) Malignant Pediatric Surgery 12 (6.7) 168 (93.3) 0.125 Gynecology 6 (14.0) 37 (86.0) Conclusion: Pediatric surgeons tend to perform fewer OPs for benign lesions compared with gynecologists. The comparable NNH for both specialties is likely due to the low prevalence of malignant tumors. Considering most pediatric ovarian malignancy is germ-cell origin with exceptional salvage rate, pediatric surgeons might be overtreating ovarian lesions in children. Influence of Obesity on Endometrial Ablation Outcomes: Is There Potential to Predict Procedure Failure? Emily Tran, BS, Jasmine Park, DO, Emily Meale, Deeksha Kommireddi, Salma Maher, Vincent A Torelli, DO Rowan-Virtua School of Osteopathic Medicine, Winslow Township, NJ; Mt. Sinai Morningside, West Internal Medicine, Bronx, NY Introduction: The prevalence of obesity continues to grow and is considered a national health crisis. The pathophysiology of obesity regarding endometrial disorders is well documented, however, the effect on gynecologic procedural outcomes, specifically endometrial ablation (EA), is poorly understood. It is hypothesized that obesity (BMI > 30 kg/m2) increases risk of EA failure. Methods: A systematic review of literature published before February 2024 was conducted using PubMED and Embase. Search query included, “(‘obesity’/exp OR obesity) OR (‘body mass index’/exp OR ‘body mass index’) AND (‘endometrial ablation’/exp OR ‘endometrial ablation’ OR (endometrial AND ablation))”. Inclusion criteria encompassed studies examining obesity as a prognostic factor for EA outcomes. No limitations were set on types of studies included. Criteria for EA failure included post-EA reintervention, hysterectomy, recurrent uterine bleeding, menorrhagia, or endometrial pathology. A meta-analysis was conducted on pooled data from studies meeting the above criteria. An odds ratio (OR) was calculated as the prevalence of EA failure in obese women compared with non-obese women using Review Manager 5. Results: A total of 5 studies encompassing 3067 total participants were included. 431 obese and 663 non-obese participants encountered failure after EA, respectively. Meta-analysis computation yielded an overall OR of 1.42 favoring obese women (Figure 1).Figure 1Conclusion: This analysis shows that obese women are at increased risk of failure after EA compared with non-obese women. This could be secondary to reaccumulation of pathologic endometrial tissue related to estrogen from excess adipose tissue. Given increased risk of EA failure in obesity, pre-procedural evaluation counseling weight loss may improve EA success. Pectineal Hysteropexy: A New Option for Prolapse Operation with Uterine Conservation Mirali Shah, John Heusinkveld, MD, FACS University of Arizona, Tucson, AZ Introduction: Pectineal hysteropexy is a novel method of prolapse repair that was introduced to North America by our group in 2020. It may be particularly well suited for older patients in whom a short anesthetic time and rapid recovery are particularly desirable, due to short operative time. Because most patients have an anterior as well as an apical defect, the use of the pectineal ligaments instead of the sacrum as attachment points avoids the need to tunnel the mesh through the cardinal ligaments, as is required for sacral hysteropexy when an anterior defect is present. Methods: Under IRB protocol #1503757551R002 a retrospective review of all pectineal hysteropexies from February 2022 through May 2023 was performed. Results: Thirty-six pectineal hysteropexies were performed. The average age of patients was 70 years. There were no Clavien-Dindo grade II or above complications. Two patients were treated for cystitis and 1 was treated for endometritis postoperatively. Three patients returned with Stage II anterior wall prolapse, of whom 1 elected to have a reoperation. One patient underwent reoperation for a rectocele that was not felt significant at the time of her original operation. The average operative time was 118 minutes. Conclusion: Pectineal hysteropexy is a promising technique that demonstrated excellent safety and yielded short-term results comparable to other prolapse operations in an elderly population. We believe that the relatively short operative times demonstrated in our study may lead to improved outcomes in older patients. Quality of Life and Care Priorities after Cervical Cancer Treatment: A Survey of 100 Survivors Edward A Joseph, MBBS, Mathangi Chandramouli, MD, Yue Yin, PhD, Sarah Crafton, MD, Casey J Allen, MD, FACS Allegheny Singer Research Institute, Pittsburgh, PA; Allegheny Health Network, Pittsburgh, PA Introduction: This study evaluates the quality of life (QOL) and subsequent care-priorities of cervical cancer survivors. Methods: We surveyed cervical cancer patients to evaluate their QOL via the Short Form-12 questionnaire and assessed the importance of various care priorities, overall and Results: A total of 100 were ± years and was Most common included (n = and (n = with disease. patients underwent underwent and underwent operation. the surgical underwent considered and most and were = p < QOL ± and QOL ± was lower than the ± both p < Patients who underwent lower QOL ± vs ± p = no in QOL ± vs ± p = managed patients QOL ± 12.7 vs ± p = with no in QOL ± vs ± p = There was no between short-term and QOL ± vs ± (p = QOL ± vs ± (p = (Table 1). Table 1. - Quality of Life for Cervical Cancer Based on Treatment and Variable = = p Value QOL ± ± QOL ± ± = = QOL ± 12.7 ± QOL ± ± 13.9 = = QOL ± ± QOL ± ± Conclusion: Cervical cancer patients and health their and the need for care to and the QOL of cervical cancer patients. to in Gynecologic Oncology by and the Lindsay Bryant, Edward J Pavlik, PhD University of Kentucky College of Medicine, Lexington, KY Introduction: women a diagnosis of a gynecologic have their diagnosis or that in to in have the of The and in before the of in The on in in the 12 improved the of related to gynecologic Methods: were to a common for before 2023 and in were from the related to gynecologic oncology were using as well as the and Results: The varied in length and of the an rate, In the in improved from before 2023 to in Conclusion: the of the improved in the and that is room for further improved of and of Patients MD, MD, K MD, FACS, MD Arizona, School of Medicine, Arizona, AZ Introduction: Given that and a number of women of our was to evaluate and in Methods: studies published were characteristics and number of participants included in and their and were Data was to determine the of studies race, factors and the of and and Results: A total of studies criteria for and 37 that had higher odds of more based in the and retrospective compared with studies published in the study based and (p value < increased time the of In 13 of the studies to for A total of participants had did not was and all did not and Conclusion: an in of most studies not was and a large are still using and and of in is to and improve with of Based on Uterine Cancer An College of Surgeons Analysis MD, PhD, BS, K BS, MD, MD, FACS Introduction: surgery is for uterine cancer due to to the Stage endometrial cancer 2 and We compared the outcomes of total based on these Methods: We operations using the College of Surgeons and cancer Results: the patients with and patients with were the cohort had higher hospital readmission rate vs and a higher risk of to the operating room vs patients with were older ± vs ± years), had a lower BMI ± vs ± and had a higher of vs than Multivariate showed that was with higher rate of hospital readmission ratio and a higher risk of to the operating room p were < (Table 1). Conclusion: In uterine cancer was with higher rate of to the operating room and hospital data that and uterine cancer in in fewer postoperative of Patient in a and Surgery the for Surgeons A MD, MD, FACS, PhD, MD, MD University of Introduction: Surgeons on an for patients with surgical to the operating use of in a surgical are We to evaluate a using for patient surgical Methods: This was a retrospective cohort study of an academic surgery with a all patients were by or surgeons based on or patient 2023 and the was to patients with patients who a surgical were with an Patients with or a with surgical were with an MD and surgical and after the were Results: of the more patient Table 1). more surgical and performed more a in MD by rate for and was Table 1. - and a New in a Variable = 3.4 New = New MD New 40 MD MD Conclusion: A that patients with is with more patients by and operation. The was a when for a MD Risk for Patients with BMI Surgery for Endometrial Cancer Kaitlyn Kincaid, MD, M MD, Peter W Ketch, MD, Michael Toboni, MD, MPH, Charles A Leath III, MD, MSPH, FACS, John M Straughn, MD, Teresa K Boitano, MD The University of Alabama at Birmingham, Birmingham, AL Introduction: The aim of this study was to determine the 30-day postoperative of VTE in gynecologic oncology patients with endometrial cancer and BMI 40 undergoing surgical Methods: This retrospective cohort study included gynecologic oncology patients undergoing surgery for endometrial cancer from to 2022 with BMI 40 at a academic institution. Patients were were at the time of operation. Patient characteristics were assessed age, race, BMI, Oncology performance status, and Charlson Comorbidity Index outcomes postoperative VTE rate 30 of 30-day readmission, and 30-day mortality were The was the 30-day postoperative rate of SPSS was for analysis. Results: A total of patients were included. Average BMI was kg/m2) with of patients a BMI Most patients were had a CCI of and Stage disease The rate of VTE 30 of was The 30-day readmission rate was and the 30-day mortality rate was patients received and of patients received before operation. the patients admitted all received and received with Conclusion: The rate of 30-day postoperative VTE after in patients with obesity and endometrial cancer is Given these patients not for VTE as New BS, Lindsay MD, MD, MD, FACS University of School of Medicine, Introduction: are of and for the to found in uterine and an which could be in and uterine Methods: were using were in and compared to various types in was performed with compared the Results: on a of 1 to 5 The average results of the included to the and in evaluated for in of and the and above for The in after The were on a of 1 to 3 in and The at 1 on average above the other for Conclusion: The a for this the of includes and with for and of MD, M MD, MD, Elizabeth MD, MD, FACS, MD, FACS University of Introduction: disease is a with Surgery is the of for to are to surgical which and and administration to in lesions and of was that patients with performed with the technique have fewer and lower of than those who did The of this study was to compare of surgical of after administration to surgical Methods: A retrospective study of patients with at a large center from and data were and with the of this novel technique and in surgical of Results: patients with were patients were treated with surgical 5 with surgical after patients in the group had than those who had vs and fewer in the group experienced vs Conclusion: is in resulted in fewer

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