Effect of Body Mass Index on Complications After Vaginal and Laparoscopic Apical Prolapse Surgery.

INTRODUCTION AND HYPOTHESIS: Obesity is increasing worldwide, and data are limited on how body mass index (BMI) affects surgical risk in pelvic organ prolapse. This study is aimed at evaluating the impact of obesity on outcomes after apical pelvic organ prolapse surgery. We hypothesize that obese patients have higher rates of postoperative complications. METHODS: This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2018. Current Procedural Terminology codes identified subjects aged 18-89 who underwent apical prolapse repair, including vaginal colpopexy and laparoscopic or robotic sacrocolpopexy. Minor and major complications were analyzed using the World Health Organization BMI category. Regression analysis was performed to adjust for confounders. RESULTS: The total cohort was 24,718 with 15,137 vaginal colpopexy and 9,581 laparoscopic/robotic sacrocolpopexy. The average age was 60.1, 76.5% were white, 24.2% were American Society of Anesthesiologists (ASA) class 3 or 4, and 44.7% had a major medical comorbidity. Eight hundred and eighty-five patients (5.4%) experienced a minor complication, 324 (2.0%) a major complication, and 1,167 (7.2%) any complication. There was no difference in any, major, or minor complication by BMI and this persisted after adjusting for age, race, ASA class, smoking, and surgical approach. CONCLUSIONS: There is no difference in complication rates after apical prolapse surgery by BMI regardless of age, race, ASA class, smoking use, and surgical approach. Patients and surgeons should be reassured that minimally invasive apical prolapse surgery is safe, with low complication rates. Randomized controlled trials are needed to verify these findings.

Development, Usability Testing, and Implementation Assessment of Cancer Related Infertility Score Predictor, an Online Cancer Related Infertility Risk Counseling Tool.

Purpose: Oncofertility counseling of female cancer patients lacks efficient access to tailored and valid infertility risk estimates to support shared decision-making on fertility preservation treatments. The objective was to develop, conduct user-centered design, and plan clinic-based implementation of the Cancer Related Infertility Score Predictor (CRISP), a web-based tool to support infertility risk counseling. Methods: Using a mixed methods design, literature review was undertaken to abstract data on infertility, primary ovarian insufficiency, and amenorrhea risks of common cancer treatments. The CRISP website was programmed to take user input about patient ages and cancer treatments and generate a risk summary. Using user experience methodology and semistructured interviews, usability testing and implementation assessment were conducted with 12 providers recruited from 5 medical centers in Southern California. Results: The web-based CRISP tool encompasses infertility risk data for 60 treatment regimens among 10 cancer types. Usability testing demonstrated that the tool is intuitive and informed minor modifications, including adding crowd-sourced submission of additional cancer treatments. Participants rated the tool as credible, advantageous over current provider methods to ascertain infertility risks, and useful for tailoring treatment planning and counseling patients. A key barrier was lack of information on some cancer treatments. Fit within clinical workflow was feasible, particularly with electronic health record integration. Conclusions: The novel, web-based CRISP tool is a feasible, acceptable, and appropriate tool to address provider knowledge gap about cancer related infertility risks and use for patient counseling. CRISP has significant potential to support tailored oncofertility counseling in the heterogeneous young cancer patient population.

Youth Single-Sport Specialization in Professional Baseball Players.

BACKGROUND: An increasing number of youth baseball athletes are specializing in playing baseball at younger ages. PURPOSE: The purpose of our study was to describe the age and prevalence of single-sport specialization in a cohort of current professional baseball athletes. In addition, we sought to understand the trends surrounding single-sport specialization in professional baseball players raised within and outside the United States (US). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A survey was distributed to male professional baseball athletes via individual team athletic trainers. Athletes were asked if and at what age they had chosen to specialize in playing baseball at the exclusion of other sports, and data were then collected pertaining to this decision. We analyzed the rate and age of specialization, the reasons for specialization, and the athlete's perception of injuries related to specialization. RESULTS: A total of 1673 professional baseball athletes completed the survey, representing 26 of the 30 Major League Baseball (MLB) organizations. Less than half (44.5%) of professional athletes specialized in playing a single sport during their childhood/adolescence. Those who reported specializing in their youth did so at a mean age of 14.09 ± 2.79 years. MLB players who grew up outside the US specialized at a significantly earlier age than MLB players native to the US (12.30 ± 3.07 vs 14.89 ± 2.24 years, respectively; P < .001). Additionally, MLB players raised in the US recalled a significantly higher incidence of sustaining an injury attributed to specializing in baseball than MLB athletes raised outside the US (27.7% vs 20.6%, respectively; P = .05). CONCLUSION: This study challenges the current trends toward early youth sport specialization, finding that the majority of professional baseball athletes studied did not specialize as youth and that those who did specialize did so at a mean age of 14 years. With the potential cumulative effects of pitching and overhead throwing on an athlete's arm, the trend identified in this study toward earlier specialization within baseball is concerning.

Early Single-Sport Specialization: A Survey of 3090 High School, Collegiate, and Professional Athletes.

BACKGROUND: Youth participation in organized sports in the United States is rising, with many athletes focusing on a single sport at an increasingly younger age. PURPOSE: To retrospectively compare single-sport specialization in current high school (HS), collegiate, and professional athletes with regard to the rate and age of specialization, the number of months per year of single-sport training, and the athlete's perception of injury related to specialization. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A survey was distributed to HS, collegiate, and professional athletes prior to their yearly preparticipation physical examination. Athletes were asked whether they had chosen to specialize in only 1 sport, and data were then collected pertaining to this decision. RESULTS: A total of 3090 athletes completed the survey (503 HS, 856 collegiate, and 1731 professional athletes). A significantly greater percentage of current collegiate athletes specialized to play a single sport during their childhood/adolescence (45.2% of HS athletes, 67.7% of collegiate athletes, and 46.0% of professional athletes; P < .001). The age of single-sport specialization differed between groups and occurred at a mean age of 12.7 ± 2.4 (HS), 14.8 ± 2.5 (collegiate), and 14.1 ± 2.8 years (professional) (P < .001). Current HS (39.9%) and collegiate athletes (42.1%) recalled a statistically greater incidence of sport-related injury than current professional athletes (25.4%) (P < .001). The majority (61.7%) of professional athletes indicated that they believed specialization helps the athlete play at a higher level, compared with 79.7% of HS and 80.6% of collegiate athletes (P < .001). Notably, only 22.3% of professional athletes said they would want their own child to specialize to play only 1 sport during childhood/adolescence. CONCLUSION: This study provides a foundation for understanding current trends in single-sport specialization in all athletic levels. Current HS athletes specialized, on average, 2 years earlier than current collegiate and professional athletes surveyed. These data challenge the notion that success at an elite level requires athletes to specialize in 1 sport at a very young age.