Work-related musculoskeletal disorders are prevalent among surgeons but have received little attention owing to under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed to protect surgeons from preventable, potentially career-altering injuries.

Introduction and hypothesisThe purpose of this study is to identify risk factors for mesh erosion in women undergoing minimally invasive sacrocolpopexy (MISC). We hypothesize that erosion is higher in subjects undergoing concomitant hysterectomy.MethodsThis is a retrospective cohort study of women who underwent MISC between November 2004 and January 2009. Demographics, operative techniques, and outcomes were abstracted from medical records. Multivariable regression identified odds of erosion.ResultsOf 188 MISC procedures 19(10%) had erosions. Erosion was higher in those with total vaginal hysterectomy (TVH) compared to both post-hysterectomy (23% vs. 5%, p = 0.003) and supracervical hysterectomy (SCH) (23% vs. 5%, p = 0.109) groups. In multivariable regression, the odds of erosion for TVH was 5.67 (95% CI: 1.88–17.10) compared to post-hysterectomy. Smoking, the use of collagen-coated mesh, transvaginal dissection, and mesh attachment transvaginally were no longer significant in the multivariable regression model.ConclusionBased on this study, surgeons should consider supracervical hysterectomy over total vaginal hysterectomy as the procedure of choice in association with MISC unless removal of the cervix is otherwise indicated.

OBJECTIVE: To compare the effect of same-day discharge on 30-day readmission risk after minimally invasive pelvic reconstructive surgery. METHODS: This retrospective cohort study included all minimally invasive pelvic reconstructive procedures with and without concomitant hysterectomy performed within a large managed care organization of 4.5 million members from 2008 to 2018. We queried the system-wide medical record for Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revision codes for all included procedures and patient perioperative data. Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department (ED) visits. Perioperative data and 30-day outcomes were compared using χ2 for categorical variables and Kruskal-Wallis for continuous variables. We performed a multivariate logistic regression adjusting for perioperative variables and their potential effect. RESULTS: Of the 13,445 patients undergoing pelvic reconstructive surgery, 5,506 were discharged the same day and 7,939 were discharged the next day. There was no difference in 30-day readmission comparing those discharged the same day with those discharged the next day (odds ratio [OR] 0.79; 95% CI 0.60–1.03; 1.5% vs 2.0%, P=.07). Concomitant hysterectomy was performed in 6,171 individuals: There was no difference (OR 0.90; 95% CI 0.60–1.33; 1.9% vs 2.1%, P=.59) in 30-day readmission rates when comparing those discharged on the same day with those discharged the next day. We also found no difference in 30-day readmissions rates when comparing same-day with next-day discharge (OR 1.33, 95% CI 0.79–2.26; 2.8% vs 2.1%, P=.28) in (n=3,482) individuals undergoing vaginal hysterectomy. For those who did not undergo hysterectomy at the time of their prolapse surgery, there was no difference (OR 0.77; 95% CI 0.53–1.13; 1.3% vs 1.7%, P=.18) in 30-day readmission when comparing those discharged the same day with those discharged the next day. After adjustment for patient and perioperative characteristics, there was no statistically significant difference in the readmission risk for individuals with same-day discharge compared with next-day discharge among those with (adjusted odds ratio [aOR] 0.91; 95% CI 0.61–1.36; P=.63) and without (aOR 0.86; 95% CI 0.58–1.27; P=.45) a concomitant hysterectomy. For the secondary outcome of 30-day ED visits, we found no statistically significant differences when comparing same-day with next-day discharge for the entire cohort, those with concomitant hysterectomy, or when controlling for patient and perioperative characteristics. CONCLUSION: In women undergoing minimally invasive pelvic reconstructive surgery within a large managed care organization, there is no difference in 30-day readmission or ED visit rates between those discharged the same day and those discharged the next day. When considering patient factors, same-day discharge after minimally invasive pelvic reconstructive surgery may be safe and play an important role in value-based care.