Activity

To evaluate postoperative opioid filling patterns for patients undergoing isolated midurethral sling placement.

Patients undergoing midurethral sling placement from 2005 to 2016 were identified in the Truven Health MarketScan database. We determined whether sling placement was an isolated procedure or performed in conjunction with other benign gynecologic procedures. All outpatient prescription drug claims for opioids were extracted from 28 days before surgery to 28 days after surgery. We identified the number of prescriptions filled and calculated morphine milligram equivalents (MMEs) in the allotted perioperative windows. The proportion of patients with opioid prescription claims and cumulative MMEs were compared for multiple versus isolated procedures using χ2 and Wilcoxon tests, respectively.

The cohort included 153,631 patients, with 79,069 (51.5%) having an isolated procedure and 74,562 (48.5%) having multiple benign procedures. Seventy-two percent of the patients undergoing isolated midurethral sling placement received at least 1 opioid prescription in the study period compared with 79% of those undergoing combined procedures (P < 0.001). The median cumulative MMEs for isolated midurethral sling and midurethral sling + multiple procedures were 150 and 225 MMEs, respectively (P < 0.001). Across the years under study, the proportion of patients filling opioid prescription claims increased, but the median cumulative MME was unchanged.

Patients undergoing isolated midurethral sling placement filled a median of 150 cumulative MMEs, and the proportion of patients filling perioperative opioid prescriptions increased over the study period.

Patients undergoing isolated midurethral sling placement filled a median of 150 cumulative MMEs, and the proportion of patients filling perioperative opioid prescriptions increased over the study period.

There is a paucity of data on postoperative exercise and how it relates to surgical failure, specifically after midurethral sling (MUS) surgery. We aimed to assess if women with higher self-reported activity levels as measured by strenuous exercise are more likely to experience stress urinary incontinence (SUI) symptoms after MUS than women with lower self-reported activity.

This is a secondary analysis of Operations and Pelvic Muscle Training in the Management of Apical Support Loss the OPTIMAL Trial, a randomized trial comparing sacrospinous ligament suspension versus uterosacral ligament suspension, both with concomitant retropubic MUS. Participants completed a validated assessment of activity preoperatively and postoperatively. Women in the upper quartile for strenuous exercise (≥90 minutes per week) were compared with the remaining participants. Symptomatic SUI was defined as retreatment or reoperation for SUI and/or any positive response to Pelvic Floor Disorders Inventory stress incontinence questions 20 to 22.

A total of 351 participants in the OPTIMAL study received MUS along with their prolapse repair and had postoperative exercise and Pelvic Floor Disorders Inventory data. At 2 years, 87 (29%) of 305 exercised strenuously for at least 90 minutes per week, and 63 (23%) of 277 experienced SUI. Women who were less active at 2 years were significantly more likely to experience SUI than women who were more active (26.6% vs 12.8%, P = 0.0138).

In this study, symptomatic SUI occurred more frequently in women with lower self-reported exercise levels 2 years after MUS surgery.

In this study, symptomatic SUI occurred more frequently in women with lower self-reported exercise levels 2 years after MUS surgery.

The purpose of this study was to describe preference for and knowledge of hysterectomy routes in women presenting to urogynecology/gynecology clinics throughout the United States and to determine association with health literacy. Our primary aim was preference for hysterectomy route, and secondary aims were knowledge of basic pelvic structures and function, knowledge of various hysterectomy routes, and baseline health literacy level.

This multicenter, cross-sectional study was conducted through the Fellows’ Pelvic Research Network. Patients’ preference and knowledge for hysterectomy routes were assessed at initial presentation to the urogynecology/gynecology clinic with an anonymous, voluntary, self-administered questionnaire along with a validated health literacy test (Medical Term Recognition Test).

Two hundred four women participated. Forty-five percent of patients were unsure which hysterectomy modality they would choose. Of patients who selected a preferred modality, 50% selected laparoscopic and 3ectomy routes, but were not found to influence patient preference for hysterectomy route. Temsirolimus ic50 Overall, patients have limited knowledge of vaginal hysterectomy.

The Birmingham Hip Resurfacing (BHR) prosthesis is the most commonly used metal-on-metal hip resurfacing arthroplasty device. The current manufacturer-recommended target demographic for the BHR is male patients, younger than 65 years requiring a femoral head size of ≥ 50 mm. Female patients, older patients, and individuals with smaller femoral-head diameter (≤ 50 mm) are known to have higher revision rates. Prior studies suggest that the survivorship of the BHR when used in the target demographic is comparable with that of primary conventional THA, but comparing survivorship of the most durable hip resurfacing arthroplasty device to the survivorship of all conventional THA prostheses is not ideal because the THA group comprises a large number of different types of prostheses that have considerable variation in prosthesis survival. A more informative comparison would be with the THA implants with the best survivorship, as this might help address the question of whether survivorship in the BHR target populatie of revision for primary THA accounting for 1.7% of all primary THA procedures. Minor revisions (head, inset or both) were undertaken in a further 0.6% of primary THA procedures.

Given the increasing revision risk of the BHR compared with better-performing conventional THA prostheses in the target population, we recommend that patients be counseled about this risk. We suggest that a THA with proven low revision rates might be the better choice, particularly for patients who are concerned about implant durability. Well-controlled prospective studies that show appreciable clinically important differences in patient-reported outcomes and functional results favoring the BHR over conventional THA prostheses using modern bearings are needed to justify the use of the BHR in view of this revision risk.

Level III, therapeutic study.

Level III, therapeutic study.