to operative time. Operative times were divided into 60-minute intervals and complication rates analyzed. Bivariate analysis and multivariate regression modeling were performed to assess the association between operative time and complications. Results: A total of 16,864 abdominal hysterectomy procedures were identified. Rates of 30-day overall, medical, surgical complications, and reoperation were 12.4%, 9.2%, 4.2%, and 1.7%, respectively. Complication rates increased significantly with increasing operative time, with an inflection point noted at 180 minutes. Patients with operative time R180 minutes were more likely to be >50 years old, obese, nonsmokers, diabetic, hypertensive, ASA class 3-4, and to have higher RVU coded for the procedure. On bivariate analysis, operative time R180 minutes was associated with increased overall complications (25% versus 10.4%, p \ 0.001), surgical complications (7.1 versus 3.1%, p \ 0.001), medical complications (19.9% versus 7.5%, p \ 0.001), reoperation (2.5% versus 1.6%, p = 0.001), blood transfusion (14.3% versus 4%, p \ 0.001), deep venous thrombosis (0.5% versus 0.2%, p = 0.002), pulmonary embolism (1.1% versus 0.3%, p \ 0.001), and urinary tract infection (3.8% versus 2.3%, p \ 0.001). Mortality was low in both groups at 0.1%. After multivariable regression analysis, operative time R180 minutes was independently predictive of overall complications (OR = 2.3, 95% CI = 2.0 to 2.5, p \ 0.001), medical complications (OR = 2.4, 95% CI = 2.1 to 2.8, p \ 0.001), surgical complications (OR = 1.6, 95% CI = 1.3 to 1.9, p \ 0.001), blood transfusion (OR = 3.0, 95% CI = 2.5 to 3.4, p \ 0.001), venous thromboembolism (OR = 2.6, 95% CI = 1.7 to 4.0, p \ 0.001), and urinary tract infection (OR = 1.5, 95% CI = 1.2 to 1.9, p = 0.002). Conclusion: We have demonstrated a direct, independent correlation between increased operative time during abdominal hysterectomy and increased 30-day overall complications, medical complications, surgical complications, reoperation, blood transfusion, venous thromboembolism, and urinary tract infection. Additional study is needed regarding risk factors for prolonged operative time in hysterectomy, the comparative advantages and morbidity of minimally invasive hysterectomy relative to abdominal hysterectomy, and the relationship of these differential risks to operative time.

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The Hypoxia Inducible Factor (HIF) system has been characterized as the principal tissue level response to hypoxia. Posttranslational regulation of HIF‐1alpha has been reported to act though a Hypoxia Responsive Element (HRE) promoter region on a range of hypoxia‐induced genes. A plasmid was constructed consisting of a fivefold HRE repeat conjugated to a luciferase gene, used as a marker for HRE activation. Plasmid HRE‐luciferase was then transfected into a well‐established ischemic rabbit ear wound healing model. Ischemia was induced using a variety of published models for interruption of arterial inflow and compared with a nonischemic control. Central artery, caudal artery and rostrocaudal artery models were tested for induction of ischemia. Tissue specimens were harvested from the transfected areas and solubilized. Luminescence of each specimen was measured using a standard luminometer to quantify luciferase induction. To provide correlation on a regional level, tissue level oxygen tension was measured directly for each wound model. Profound and statistically significant differences were found in the induced luciferase production. Marked differences in the tissue hypoxia between the various ischemic wound healing models correlated in graded fashion with the ischemia induced on an anatomic basis. The least ischemic model showed no significant difference in hypoxia readings versus control. The intermediate model showed a significant fourfold greater ischemia signaling. The most ischemic model showed a highly significant 72‐fold greater ischemic response compared to controls. The use of gene transfection is described as a sensitive and effective method for quantification of tissue hypoxia at a cellular level in ischemic wounds. Acknowledgments:  This study was funded by the Wound Healing Research Laboratory.

At follow-up, there was no difference between groups for women who achieved all symptom (85% vs 74%, P¼0.2) and all function goals (89% vs 74%, P¼0.2). On multiple logistic regression, only education level greater than college was associated with not achieving all goals (OR 3.0, 95% CI 1.2-7.6). Women who discontinued or crossed-over to surgery had smaller improvements in PFDI, PFIQ, and BIS scores and a lower proportion of goals achieved (P<0.05 for all) at the time of pessary discontinuation. CONCLUSION: Women experience long-term improvements in symptoms and quality of life with either surgical or pessary treatment of POP. Although these improvements are higher in women who opt for surgical treatment, attainment of pre-treatment goals is successful with either treatment modality. This information can be useful for the decision-making process of women considering treatment for POP.