Faculty Bibliography

OBJECTIVE/UNASSIGNED:Determine whether the quadratus lumborum block (QLB) is an effective adjunct to control postoperative pain during the first 24 hours after minimally invasive hysterectomy. METHODS/UNASSIGNED:Prospective cohort observational study of patients who underwent laparoscopic or robotic hysterectomy. Patients either received a QLB or did not. Initial postoperative pain scores were recorded in the postanesthesia recovery area using a numeric rating scale. Patients were then called to collect 24-hour scores and analgesic medication usage. The primary outcome was the 3-hour pain score. Secondary analysis evaluated use of analgesic medication. RESULTS/UNASSIGNED: = .384) in the QLB group. Opioid, acetaminophen, and ibuprofen usage was not significantly different between groups. CONCLUSION/UNASSIGNED:There was no significant pain difference between the no-QLB and QLB groups. Patients who received a QLB were more likely to receive pain medication 3 hours after surgery. Thus, the use of a QLB does not appear to be a suitable adjunct for postoperative pain.

PURPOSE:To examine whether there are differences in meeting treatment goals between pelvic floor physical therapy (PFPT) patients who participated in a majority of telehealth visits versus those who participated in mostly traditional office visits at a community hospital. METHODS:Retrospective chart review was performed among patients who received PFPT from April 2019 to February 2021. Cohorts were defined as "Mostly Office Visits" (> 50% office visits) and "Mostly Telehealth" (> / = 50% telehealth visits). Primary outcome measures included demographic data, number/type of visit for each patient, number of no-show/cancelation appointments, and number of patients discharged meeting PFPT goals. Statistical significance was defined as p < 0.05. RESULTS:234 subjects met criteria for the "Mostly Office Visit" cohort and 48 subjects met criteria for the "Mostly Telehealth" cohort. There were no significant differences observed in age (p = 0.919), BMI (p = 0.817), race/ethnicity (p = 0.170) or insurance type (p = 0.426) between cohorts. There was no significant difference in meeting PFPT goals between the "Mostly Office Visit" cohort (24.4%) and the "Mostly Telehealth" cohort (35.4%) (p = 0.113). There was no difference in the number of canceled visits per patient (mean cancelations "Office visit" 1.98; "Telehealth" 1.63; p = 0.246) and the number of no-show visits per patient (mean no-show's "Office visit" 0.23; "Telehealth" 0.31; p = 0.297) between cohorts. CONCLUSION:There was no difference in meeting discharge goals regardless of whether a patient participated in mostly telehealth visits versus mostly traditional office visits. Therefore, we can conclude that participating in mostly provider-led telehealth visits can be equally efficacious at providing competent PFPT care.

BACKGROUND:Minimally invasive hysterectomy is a common gynecologic procedure. Numerous studies have found that a same day discharge (SDD) is safe following this procedure. Research has found that SDDs decrease resource strain, nosocomial infections, and financial burden for both the patient and healthcare system. Due to the recent COVID-19 pandemic, the safety of hospital admissions and elective surgeries was called into question. OBJECTIVE:To assess the rates of SDD among patients who underwent a minimally invasive hysterectomy before and during the COVID-19 pandemic. STUDY DESIGN/METHODS:A retrospective chart review was performed from September 2018 to December 2020 on 521 patients, who met inclusion criteria. Descriptive analysis, chi-square tests of association, and multivariable logistic regression were used for analysis. RESULTS:There was a significant difference between rate of SDDs pre-COVID-19 (12.5%) versus during the COVID-19 period (28.6%) (p < 0.001). Surgical complexity was predictive of not being discharged the same day of surgery (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 2.2-8.8), as was surgical completion time after 4 p.m. (OR = 5.2, 95% CI = 1.1-25.2). There was no difference in readmissions (p = 0.209) and emergency department (ED) visits (p = 0.973) between SDD and overnight stay. CONCLUSION/CONCLUSIONS:Rates of SDD for patients undergoing minimally invasive hysterectomy were significantly increased during the COVID-19 pandemic. SDDs are safe; the number of readmissions and ED visits did not increase among patients who were discharged on the same day.

BACKGROUND/UNASSIGNED:Hysteroscopy is the gold standard for evaluating intrauterine pathology. The majority of physicians currently perform hysteroscopy in the operating room. Lack of training has been cited as a barrier to performing office hysteroscopy; however, resident training in office hysteroscopy has not yet been evaluated. METHODS/UNASSIGNED:A prospective cross-sectional survey was performed. A validated 17 question survey tool was sent to 297 program directors of Accreditation Council for Graduate Medical Education accredited obstetrics and gynecology residency programs for distribution to their residents. The survey utilized a Likert scale to assess resident interest in learning office hysteroscopy, satisfaction in training, and perceived self-efficacy to perform office hysteroscopy independently upon graduation. RESULTS/UNASSIGNED:0.019). Ninety-four percent of residents reported interest in learning office hysteroscopy. Satisfaction with hysteroscopy training in the operating room versus the office was 91.1% vs. 11.3% respectively. Of the fourth-year residents, 17.4% felt they could perform office hysteroscopy independently upon graduation and 14.5% reported feeling comfortable performing the procedure. CONCLUSIONS/UNASSIGNED:Residency training in office hysteroscopy is lacking and residents are unprepared to perform the procedure after graduation. Enhanced residency training in office hysteroscopy would likely improve resident comfort and ability to perform office hysteroscopy in practice.

Non-invasive techniques for quantifying early biochemical and biomechanical changes in articular cartilage may provide a means of more precisely assessing osteoarthritis (OA) progression. The goals of this study were to determine the relationship between T1rho magnetic resonance (MR) imaging relaxation times and changes in cartilage composition, cartilage mechanical properties, and synovial fluid biomarker levels and to demonstrate the application of T1rho imaging to evaluate cartilage composition in human subjects in vivo. Femoral condyles and synovial fluid were harvested from healthy and OA porcine knee joints. Sagittal T1rho relaxation MR images of the condyles were acquired. OA regions of OA joints exhibited an increase in T1rho relaxation times as compared to non-OA regions. Furthermore in these regions, cartilage sGAG content and aggregate modulus decreased, while percent degraded collagen and water content increased. In OA joints, synovial fluid concentrations of sGAG decreased and C2C concentrations increased compared to healthy joints. T1rho relaxation times were negatively correlated with cartilage and synovial fluid sGAG concentrations and aggregate modulus and positively correlated with water content and permeability. Additionally, we demonstrated the application of these in vitro findings to the study of human subjects. Specifically, we demonstrated that walking results in decreased T1rho relaxation times, consistent with water exudation and an increase in proteoglycan concentration with in vivo loading. Together, these findings demonstrate that cartilage MR imaging and synovial fluid biomarkers provide powerful non-invasive tools for characterizing changes in the biochemical and biomechanical environments of the joint.