Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

Mandelbaum, Rachel S.; Smith, Meghan B.; Roman, Lynda D.; Paulson, Richard J.; Matsuo, Koji

doi:10.1016/j.fertnstert.2019.07.235

Cited by 9 publications

(16 citation statements)

References 30 publications

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“…For study covariates, patient baseline demographics, hospital information, and pregnancy characteristics were abstracted from the program for the study covariates, which were grouped similarly to previous studies from the database 17–19 . Patient demographics included age (continuous), year (trisected to every 13‐month interval as October 2015 to October 2016, November 2016 to November 2017, and December 2017 to December 2018), admission type (elective vs non‐elective), race/ethnicity (white, black, Hispanic, Asian/Pacific Islander, Native American, and others) grouped per the program, median household income (every quartile), primary expected payer (Medicaid, private including Health Maintenance Organization, and others), obesity (grouped per CDC classification: non‐obesity, class I–II, and class III), and tobacco use (yes or no).…”

Section: Methodsmentioning

confidence: 99%

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

Matsuo

Matsuzaki

Vestal

et al. 2021

Acta Obstet Gynecol Scand

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Introduction This study examined national‐level trends, characteristics, and perioperative outcomes of women who had intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum (PAS). Material and methods This was a population‐based retrospective observational study that queried the National Inpatient Sample from October 2015 to December 2018. Study population was women who underwent hysterectomy at cesarean delivery for PAS (n = 6440 in 806 centers). Exposure allocation was the use of intra‐arterial balloon occlusion. Main outcome measures were (a) characteristics associated with intra‐arterial balloon occlusion use, and (b) perioperative outcome including hemorrhage, blood transfusion, coagulopathy, shock, urinary tract injury, intra‐arterial balloon occlusion‐related complication (arterial injury, arterial thrombosis, and lower extremities ischemia), and death, assessed in multivariable analysis. Results Intra‐arterial balloon occlusion was used in 420 (6.5%) women in 64 (7.9%) centers. Utilization of intra‐arterial balloon occlusion during cesarean hysterectomy for placenta accreta decreased significantly over time (from 6.3% to 3.1%, p < 0.001), but not in placenta increta (from 12.8% to 9.3%, p = 0.204) or placenta percreta (from 21.3% to 17.5%, p = 0.344). In a multivariable analysis, patient factors (younger age, earlier year, obesity, diabetes mellitus), pregnancy factors (placenta increta/percreta, previous cesarean delivery, placenta previa, and early gestational age), and facility factors (large bed capacity, urban teaching status, and Northeast/West regions) represented the independent characteristics for using the intra‐arterial balloon occlusion (all, p < 0.05). In a classification‐tree model, the absolute difference in intra‐arterial balloon occlusion use among 18 utilization patterns was 48% (range, 0%–48%). In perioperative outcome analysis, women who received intra‐arterial balloon occlusion were more likely to have coagulopathy (adjusted odds ratio [aOR] 3.43) and arterial thrombosis (aOR 9.82) in placenta accreta, but less likely to have hemorrhage (aOR 0.25) in placenta increta, and blood transfusion (aOR 0.60) and urinary tract injury (aOR 0.28) in placenta percreta compared with those who did not (all, p < 0.05). Conclusions There is a wide range in the utilization of intra‐arterial balloon occlusion at cesarean hysterectomy for PAS based on patient, pregnancy, and facility factors, which implies that there is a lack of universal practice guidelines in this surgical procedure. Whether the use of intra‐arterial balloon occlusion in the severe forms of PAS improves surgical outcome merits further investigation.

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Section: Methodsmentioning

confidence: 99%

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

Matsuo

Matsuzaki

Vestal

et al. 2021

Acta Obstet Gynecol Scand

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“…Perioperative outcomes included complications, length of stay and total charge for the index admission. Perioperative complications were abstracted as per prior studies, including hemorrhage, shock, wound complications, thromboembolism, cerebrovascular disease or stroke, cardiac failure, myocardial infarction, pneumonia, respiratory failure, systemic inflammatory response syndrome or sepsis, ileus or small bowel obstruction, vascular injury, acute kidney injury, pyelonephritis, abscess, fistula, intestinal perforation, position‐dependent complication, and death during the index admission (Table ) 16‐18 . Perioperative complications included both intraoperative and postoperative complications before hospital discharge, which are not distinguishable in the NIS database.…”

Section: Methodsmentioning

confidence: 99%

National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

Matsuo

Mandelbaum

Nusbaum

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. Material and methods This is a population‐based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509 395 women who underwent hysterectomy for benign gynecological disease: 430 865 (84.6%) non‐obese women, 50 435 (9.9%) women with class I‐II obesity and 28 095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort‐level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient‐level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple‐group generalized boosted model. Results The rate of class III obesity increased by 40.4%, higher than the rate of class I‐II obesity (22.2%) (both, P < .001). In parallel, cohort‐level rates of perioperative complication and prolonged hospitalization for ≥7 days increased by 19.4% and 54%, respectively (P < .001). In a weighted model, class I‐II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08‐1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28‐1.51) had a significantly increased risk of perioperative complications compared with non‐obesity. Larger body habitus was associated with higher total charge (median, $35 180, $36 094 and $39 382; all values cited in US dollars) and prolonged admission rate for ≥7 days (2.9%, 3.1% and 3.9%) (both, P < .001). Conclusions The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society‐based approaches are necessary to reduce the obesity rate and hysterectomy morbidity.

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“…Historically, preservation of the adnexa was not performed due to concern of releasing thrombotic emboli into circulation, but this has been disproven [44,45]. A recent retrospective study found that the performance of conservative surgery for adnexal torsion had increased between 2001 and 2015 from 18.9% to 25.1%, and was associated with an approximately 30% decreased risk of perioperative complications [43]. Several studies performed have shown that intraoperative diagnosis of ovarian necrosis is not accurate [46][47][48].…”

Section: Treatmentmentioning

confidence: 99%

Adnexal torsion: a review of diagnosis and management strategies

Chang-Patel

Palacios-Helgeson

Gould

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewAdnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. Recent findingsCommon findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18--20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively.

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Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

Cited by 9 publications

References 30 publications

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

Utilizations and outcomes of intra‐arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum

National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

Adnexal torsion: a review of diagnosis and management strategies

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