Publications

The World Health Organization recommends anthelminthic treatment for pregnant women after the first trimester in soil-transmitted helminth (STH) endemic regions to prevent adverse maternal-fetal consequences. Although studies have shown the high prevalence of infection in the Philippines, no research has evaluated deworming practices. We hypothesized that pregnant women are not receiving deworming treatment and we aimed to identify barriers to World Health Organization guideline implementation. We conducted key informant interviews with local Department of Health (DOH) administrators, focus group discussions with nurses, midwives, and health care workers, and knowledge, attitudes, and practices surveys with women of reproductive age to elicit perspectives about deworming during pregnancy. Key informant interviews revealed that healthcare workers were not deworming pregnant women due to inadequate drug supply, infrastructure and personnel as well as fear of teratogenicity. Focus group discussions showed that healthcare workers similarly had not implemented guidelines due to infrastructure challenges and concerns for fetal malformations. The majority of local women believed that STH treatment causes side effects (74.8%) as well as maternal harm (67.3%) and fetal harm (77.9%). Women who were willing to take anthelminthics while pregnant had significantly greater knowledge as demonstrated by higher Treatment Scores (mean rank 146.92 versus 103.1, z = -4.40, p<0.001) and higher Birth Defect Scores (mean rank 128.09 versus 108.65, z = -2.43, p = 0.015). This study concludes that World Health Organization guidelines are not being implemented in the Philippines. Infrastructure, specific protocols, and education for providers and patients regarding anthelminthic treatment are necessary for the successful prevention of STH morbidity and mortality among pregnant women.

PURPOSE

We identified rates of and risk factors for complications after colpocleisis using the American College of Surgeons NSQIP® database.

MATERIALS AND METHODS

Women treated with Le Fort colpocleisis from 2005 to 2011 were identified in the database. Primary outcomes were 30-day complication rates. Secondary outcomes were risk factors for complications and the impact of age and a concomitant sling on morbidity. Clinical and procedural characteristics were compared using the chi-square test and 1-way ANOVA.

RESULTS

We identified 283 women, of whom 23 (8.1%) experienced complications. The most common complication was urinary tract infection in 18 women (6.4%). There was 1 death for a 0.4% mortality rate. Increased complications were associated with age less than 75 years (p = 0.03), chronic obstructive pulmonary disease (p = 0.03), hemiplegia (p = 0.03), disseminated cancer (p = 0.03) and open wound infection (p = 0.02). Six patients (2.1%) required return to the operating room within 30 days. Complication rates did not differ based on operative time (p = 0.78), inpatient status (p = 0.24), resident involvement (p = 0.35), concomitant sling placement (p = 0.81) or anesthesia type (p = 0.27). Women undergoing colpocleisis without (191) and with (92) a sling had similar baseline characteristics. Colpocleisis without and with a sling had similar rates of complications (7.9% vs 8.7%, p = 0.81), urinary tract infection (5.8% vs 7.6%, p = 0.55), return to the operating room (2.1% vs 2.2%, p = 0.97) and mortality (0% vs 1.1%, p = 0.15).

CONCLUSIONS

Mortality and complication rates after colpocleisis are low with urinary tract infection being the most common postoperative complication. Concomitant sling placement does not increase 30-day complication rates.

BACKGROUND

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality, particularly in the postoperative setting. Various risk stratification schema exist in the plastic surgery literature, but do not take into account variations in procedure length. The putative risk of VTE conferred by increased length of time under anaesthesia has never been rigorously explored.

AIM

The goal of this study is to assess this relationship and to benchmark VTE rates in plastic surgery.

METHODS

A large, multi-institutional quality-improvement database was queried for plastic and reconstructive surgery procedures performed under general anaesthesia between 2005-2011. In total, 19,276 cases were abstracted from the database. Z-scores were calculated based on procedure-specific mean surgical durations, to assess each case's length in comparison to the mean for that procedure. A total of 70 patients (0.36%) experienced a post-operative VTE. Patients with and without post-operative VTE were compared with respect to a variety of demographics, comorbidities, and intraoperative characteristics. Potential confounders for VTE were included in a regression model, along with the Z-scores.

RESULTS

VTE occurred in both cosmetic and reconstructive procedures. Longer surgery time, relative to procedural means, was associated with increased VTE rates. Further, regression analysis showed increase in Z-score to be an independent risk factor for post-operative VTE (Odds Ratio of 1.772 per unit, p-value < 0.001). Subgroup analyses corroborated these findings.

CONCLUSIONS

This study validates the long-held view that increased surgical duration confers risk of VTE, as well as benchmarks VTE rates in plastic surgery procedures. While this in itself does not suggest an intervention, surgical time under general anaesthesia would be a useful addition to existing risk models in plastic surgery.