Faculty Bibliography

BACKGROUND/UNASSIGNED:A current standard treatment for pre- or perimenopausal women with high-risk early-stage, hormone receptor-positive breast cancer who have undergone definitive surgery is adjuvant treatment with ovarian function suppression (OFS) with a GnRH agonist (leuprolide or goserelin) with endocrine therapy with an aromatase inhibitor or tamoxifen. Routine measurement of serum estradiol levels for monitoring of OFS during treatment is not a part of current NCCN guidelines. The frequency of estradiol monitoring is therefore often at the discretion of the clinician, and the goal estradiol level is not well established. CASE PRESENTATION/UNASSIGNED:We present the case of a 47-year-old female with high-risk early-stage hormone receptor-positive breast cancer who despite use of GnRH agonists did not achieve an estradiol level within the postmenopausal range. She had received two different GnRH agonists (leuprolide and goserelin) and later underwent a bilateral salpingo-oophorectomy (BSO). The pathology showed stromal hyperplasia in both ovaries. After the BSO in April 2024, the GnRH agonist was stopped. The serum estradiol level remained elevated (not in the postmenopausal range) after surgery for 12 months, prior to decreasing to the postmenopausal range. CONCLUSION/UNASSIGNED:Our patient's clinical course highlights the need for better understanding and establishment of monitoring guidelines for estradiol and the optimal degree of ovarian suppression for patients with breast cancer receiving OFS.

STUDY OBJECTIVE/OBJECTIVE:To determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection. DESIGN/METHODS:A multicenter prospective cohort study. SETTING/METHODS:Ten institutions in the United States. PATIENTS/METHODS:Patients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded. INTERVENTIONS/METHODS:Benign gynecologic surgery. MEASUREMENTS AND MAIN RESULTS/RESULTS:The primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4-50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks). CONCLUSION/CONCLUSIONS:In this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.

PURPOSE OF REVIEW/OBJECTIVE:Quality improvement and patient safety are relevant to the advancement of clinical care, particularly in the field of minimally invasive gynecologic surgery (MIGS). Although safety and feasibility of MIGS have been established, identification of quality metrics in this field is also necessary. RECENT FINDINGS/RESULTS:Surgical quality improvement has focused on national overarching measures to reduce mortality, surgical site infections (SSIs), and complications. Quality improvement in minimally invasive surgery has additionally led to advancements in postoperative patient recovery and long-term outcomes. Process measures in minimally invasive surgery include use of bundles and enhanced recovery after surgery (ERAS) programs. However, procedure-specific quality metrics for MIGS outcomes are poorly defined at this time. SUMMARY/CONCLUSIONS:Quality metrics in minimally invasive gynecology are well defined for structural measures and select process measures. Creation of relevant benchmarks for outcome measures in minimally invasive gynecologic surgery are needed.