TY - JOUR
T1 - Perioperative management of gynecological surgery patients
T2 - Does fellow involvement improve performance?
AU - Steiner, Holly L.
AU - Crisp, Catrina C.
AU - Pauls, Rachel N.
PY - 2013/6
Y1 - 2013/6
N2 - Introduction and hypothesis: Physicians-in-training play a role in guiding patient care, and their contributions may improve adherence to clinical practice guidelines. However, there is scant information in the literature assessing this impact on perioperative decision-making. The purpose of this study was to determine whether involvement of urogynecology fellows results in closer adherence to guidelines regarding perioperative management of gynecological patients. Methods: Retrospective analysis of patients undergoing major gynecological surgery between 1 July 2009 and 30 June 2010. Charts were identified using surgical procedure codes (SPT) and subdivided into: urogynecology (fellow co-managed) or private gynecology patients. Information was collected regarding pre- and postoperative deep venous thrombosis (DVT) prophylaxis, preoperative antibiotic type, dose, and timing. Results: Included were 699 women: 564 (81.2%) private and 135 (19.4%) urogynecology patients. Significant differences were noted in preoperative DVT prophylaxis, with the fellow-managed group being treated appropriately more often (p = 0.001). Postoperative management of thromboprophylaxis, however, was not found to be significant (p = 0.163). When evaluating antibiotic utilization, both groups were similar with regard to the timing of cephalosporins. However, fellows were significantly superior in dosing antibiotics correctly (p = 0.023), and their selection of appropriate antibiotics for penicillin-allergic subjects approached significance (p = 0.052). Conclusions: Fellow contributions toward clinical decisions resulted in more appropriate DVT prophylaxis and antibiotic administration prior to gynecological surgery.
AB - Introduction and hypothesis: Physicians-in-training play a role in guiding patient care, and their contributions may improve adherence to clinical practice guidelines. However, there is scant information in the literature assessing this impact on perioperative decision-making. The purpose of this study was to determine whether involvement of urogynecology fellows results in closer adherence to guidelines regarding perioperative management of gynecological patients. Methods: Retrospective analysis of patients undergoing major gynecological surgery between 1 July 2009 and 30 June 2010. Charts were identified using surgical procedure codes (SPT) and subdivided into: urogynecology (fellow co-managed) or private gynecology patients. Information was collected regarding pre- and postoperative deep venous thrombosis (DVT) prophylaxis, preoperative antibiotic type, dose, and timing. Results: Included were 699 women: 564 (81.2%) private and 135 (19.4%) urogynecology patients. Significant differences were noted in preoperative DVT prophylaxis, with the fellow-managed group being treated appropriately more often (p = 0.001). Postoperative management of thromboprophylaxis, however, was not found to be significant (p = 0.163). When evaluating antibiotic utilization, both groups were similar with regard to the timing of cephalosporins. However, fellows were significantly superior in dosing antibiotics correctly (p = 0.023), and their selection of appropriate antibiotics for penicillin-allergic subjects approached significance (p = 0.052). Conclusions: Fellow contributions toward clinical decisions resulted in more appropriate DVT prophylaxis and antibiotic administration prior to gynecological surgery.
KW - Antibiotic prophylaxis
KW - Fellows
KW - Perioperative management
KW - Thromboprophylaxis
UR - http://www.scopus.com/inward/record.url?scp=84879090479&partnerID=8YFLogxK
U2 - 10.1007/s00192-012-1988-4
DO - 10.1007/s00192-012-1988-4
M3 - Article
C2 - 23152051
AN - SCOPUS:84879090479
VL - 24
SP - 1025
EP - 1031
JO - International Urogynecology Journal
JF - International Urogynecology Journal
SN - 0937-3462
IS - 6
ER -