Surgical site infection after hysterectomy.

OBJECTIVE: Our objective was to estimate the occurrence of surgical site infections (SSI) after hysterectomy and the associated risk factors. STUDY DESIGN: We conducted a cross-sectional analysis of the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze hysterectomies. Different routes of hysterectomy were compared. The primary outcome was to identify the occurrence of 30-day superficial SSI (cellulitis) after hysterectomy. Secondary outcomes were the occurrence of deep and organ-space SSI after hysterectomy. Logistic regression models were conducted to further explore the associations of risks factors with SSI after hysterectomy. RESULTS: A total of 13,822 women were included in our final analysis. The occurrence of postoperative cellulitis after hysterectomy was 1.6% (n = 221 women). Risk factors that were associated with cellulitis were route of hysterectomy with an adjusted odds ratio (AOR) of 3.74 (95% confidence interval [CI], 2.26-6.22) for laparotomy compared with the vaginal approach, operative time >75th percentile (AOR, 1.84; 95% CI, 1.40-2.44), American Society of Anesthesia class ≥ 3 (AOR, 1.79; 95% CI, 1.31-2.43), body mass index ≥40 kg/m(2) (AOR, 2.65; 95% CI, 1.85-3.80), and diabetes mellitus (AOR, 1.54; 95% CI, 1.06-2.24) The occurrence of deep and organ-space SSI was 1.1% (n = 154 women) after hysterectomy. CONCLUSION: Our finding of the decreased occurrence of superficial SSI after the vaginal approach for hysterectomy reaffirms the role for vaginal hysterectomy as the route of choice for hysterectomy.

Spanish translation and validation of four short pelvic floor disorders questionnaires.

INTRODUCTION AND HYPOTHESIS: Globally, Spanish is the primary language for 329 million people; however, most urogynecologic questionnaires are available in English. We set out to develop valid Spanish translations of the Questionnaire for Urinary Incontinence Diagnosis (QUID), the Three Incontinence Questions (3IQ), and the short Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). METHODS: The TRAPD method (translation, review, adjudication, pretesting, and documentation) was used for translation. Eight native Spanish-speaking translators developed Spanish versions collaboratively. These were pretested with cognitive interviews and revised until optimal. For validation, bilingual patients at seven clinics completed Spanish and English questionnaire versions in randomized order. Participants completed a second set of questionnaires later. The Spanish versions' internal consistency and reliability and Spanish-English agreement were measured using Cronbach's alpha, weighted kappa, and intraclass correlation coefficients. RESULTS: A total of 78 subjects were included; 94.9 % self-identified as Hispanic and 73.1 % spoke Spanish as their primary language. The proportion of per-item missing responses was similar in both languages (median 1.3 %). Internal consistency for Spanish PFDI-20 subscales was acceptable to good and for PFIQ-7 and QUID excellent. Test-retest reliability per item was moderate to near perfect for PFDI-20, substantial to near perfect for PFIQ-7 and 3IQ, and substantial for QUID. Spanish-English agreement for individual items was substantial to near perfect for all questionnaires (kappa range 0.64-0.95) and agreement for PFDI-20, PFIQ-7, and QUID subscales scores was high [intraclass correlation coefficient (ICC) range 0.92-0.99]. CONCLUSIONS: We obtained valid Spanish translations of the PFDI-20, PFIQ-7, QUID, and 3IQ. These results support their use as clinical and research assessment tools in Spanish-speaking populations.

Use of patient reported outcome questionnaires in the urogynecologic literature.

AIMS: We aimed to describe the current use of patient reported outcome questionnaires (PROQ) in the urogynecologic literature. METHODS: All articles from 2009 in 11 journals were reviewed and included if PROQ were used. PROQ were assigned the grades of recommendation used by the International Consultation on Incontinence (ICI). Data were collected by two independent reviewers (differences resolved by consensus). Fisher and χ(2) tests were used for statistics. RESULTS: Of the 212 articles included, 126 used multiple PROQ. Seventy-two percent used at least one grade A PROQ and 42% exclusively used grade A PROQ. Articles about urinary incontinence (UI) were more likely to use grade A PROQ than those pertaining to interstitial cystitis or anal incontinence. Eighty-three articles used PROQ in non-English languages. These articles were as likely to use ICI grade A PROQ as those using English PROQ. When translated questionnaires are used, 41.5% of articles did not provide references for a validation of the translated version. Eighty-seven different PROQ were identified and used 422 times. Of those, 75 were developed in English. Short versions were used more frequently. PROQ available online were used 9.4 times more frequently than those requiring payment. The more utilized PROQ were more often grade A than those rarely used (P < 0.001). CONCLUSIONS: Using multiple PROQ is common in the literature reviewed. 72.2% of articles used at least one PROQ with the highest ICI recommendation but only 42% used exclusively those. Short and easily available PROQ were used more often. Most PROQ are developed in English.

Asymptomatic microscopic hematuria.

PURPOSE OF REVIEW: To examine the 2001 American Urological Association (AUA) recommendations for the evaluation of asymptomatic microscopic hematuria (AMH) in light of the most recent studies available. RECENT FINDINGS: AMH is a nonspecific marker of disease, but can also be found in healthy individuals. The research done seeks to better identify those patients who present with AMH and have a clinically significant disease. These investigations include epidemiological studies that describe populations at risk, define clinically significant hematuria, and provide long-term follow-up to patients with AMH. Authors have examined the validity and effectiveness of recommended and nonrecommended tests for AMH in different populations. Finally, several studies looked into what workup, if any, patients with AMH were receiving in the community. SUMMARY: The evaluation of female patients with AMH needs to be tailored to the individual patient's presentation and risk factors. This evaluation should be timely and always include testing of both upper and lower urinary tract. After a complete negative assessment, no further follow-up is needed.

Maternal postoperative complications after nonobstetric antenatal surgery.

OBJECTIVE: Our primary objective is to estimate the occurrence of major maternal 30 day postoperative complications after nonobstetric antenatal surgery. METHODS: We analyzed the 2005-2009 data files from the American College of Surgeons National Surgical Quality Improvement Program to assess outcomes for pregnant women undergoing nonobstetric antenatal surgery during any trimester of pregnancy as classified by CPT-4 codes. t Tests, χ(2), logistic regression and other tests were used to calculate composite 30-day major postoperative complications and associations of preoperative predictors with 30 day postoperative morbidity. RESULTS: The most common nonobstetric antenatal surgical procedure among the 1969 included women was appendectomy (44.0%). The prevalence of composite 30-day major postoperative complications was 5.8% (n = 115). This included (not exclusive categories): return to the surgical operating room within 30 days of surgery 3.6%, infectious morbidity 2.0%, wound morbidity 1.4%, 30 day respiratory morbidity 2.0%, venous thromboembolic event morbidity 0.5%, postoperative blood transfusion 0.2%, and maternal mortality 0.25%. CONCLUSION: Major maternal postoperative complications following nonobstetric antenatal surgery were low (5.8%). Maternal postoperative mortality was rare (0.25%).