微创妇科手术安全网门诊对子宫肌瘤手术的影响：前后回顾性研究

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.006

C Burns , M Cantave , C Mulligan , E Bardawil , K De Souza , K Scholl , M Tepe , D Wang , W Ross

{"title":"微创妇科手术安全网门诊对子宫肌瘤手术的影响：前后回顾性研究","authors":"C Burns , M Cantave , C Mulligan , E Bardawil , K De Souza , K Scholl , M Tepe , D Wang , W Ross","doi":"10.1016/j.jmig.2025.09.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Study Objective</h3><div>The aim of this study was to examine the impact of implementing a minimally invasive gynecologic surgery (MIGS) safety-net clinic on composite major complication rate (intraoperative and postoperative).</div></div><div><h3>Design</h3><div>Retrospective before and after study examining patients undergoing fibroid surgery before (2018-2019) and after (2021-2024) implementation of a MIGS safety-net clinic.</div></div><div><h3>Setting</h3><div>Academic tertiary referral hospital in the Midwest United States.</div></div><div><h3>Patients or Participants</h3><div>416 patients cared for at two OB/GYN safety-net clinics who underwent hysterectomy or myomectomy for symptomatic fibroids (80 patients in the before and 336 in the after subgroup).</div></div><div><h3>Interventions</h3><div>Implementation of safety-net MIGs clinic.</div></div><div><h3>Measurements and Primary Results</h3><div>Average patient age was 44.2±7.3 before and 42.8±7.0 after (p 0.092). Majority of patients self-reported race as Black 77.2% (321/416) and 66.3% (273/416) live in the 79-100%ile most disadvantaged neighborhoods in the country (as measured by the Neighborhood Atlas Area Deprivation Index). Interrupted time series segmented regression analysis adjusting for unbalanced baseline covariates was performed. Composite major complications occurred in 28% (22/80) before vs. 13% (45/336) after. The odds of having a major complication was 57% lower after implementation compared to before (OR 0.43; 95% CI 0.075-2.45). MIGS clinic implementation appeared to increase the odds of having a minimally invasive hysterectomy (59% [47/80] before vs. 72% [242/336] after; OR 2.07; 95% CI 0.46-9.25) and decrease the odds of having an open hysterectomy (34% [27/80] vs. 14% [48/363]; OR 0.56, 95% CI 0.11-2.93), although these did not reach statistical significance. Myomectomy analysis was not performed due to low frequency of procedure performance in the before period.</div></div><div><h3>Conclusion</h3><div>Implementation of a MIGS clinic for patients without previous access led to a clinically meaningful decrease in composite complication rate, increased rate of minimally invasive hysterectomy, and decreased rate of open hysterectomy, although these findings were not statistically significant. A larger sample size is needed to further assess the impact of expanded MIGS access.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S2"},"PeriodicalIF":3.3000,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Examining the Impact of a Minimally Invasive Gynecologic Surgery Safety-Net Clinic on Fibroid Surgery: A Retrospective before & after Study\",\"authors\":\"C Burns , M Cantave , C Mulligan , E Bardawil , K De Souza , K Scholl , M Tepe , D Wang , W Ross\",\"doi\":\"10.1016/j.jmig.2025.09.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Study Objective</h3><div>The aim of this study was to examine the impact of implementing a minimally invasive gynecologic surgery (MIGS) safety-net clinic on composite major complication rate (intraoperative and postoperative).</div></div><div><h3>Design</h3><div>Retrospective before and after study examining patients undergoing fibroid surgery before (2018-2019) and after (2021-2024) implementation of a MIGS safety-net clinic.</div></div><div><h3>Setting</h3><div>Academic tertiary referral hospital in the Midwest United States.</div></div><div><h3>Patients or Participants</h3><div>416 patients cared for at two OB/GYN safety-net clinics who underwent hysterectomy or myomectomy for symptomatic fibroids (80 patients in the before and 336 in the after subgroup).</div></div><div><h3>Interventions</h3><div>Implementation of safety-net MIGs clinic.</div></div><div><h3>Measurements and Primary Results</h3><div>Average patient age was 44.2±7.3 before and 42.8±7.0 after (p 0.092). Majority of patients self-reported race as Black 77.2% (321/416) and 66.3% (273/416) live in the 79-100%ile most disadvantaged neighborhoods in the country (as measured by the Neighborhood Atlas Area Deprivation Index). Interrupted time series segmented regression analysis adjusting for unbalanced baseline covariates was performed. Composite major complications occurred in 28% (22/80) before vs. 13% (45/336) after. The odds of having a major complication was 57% lower after implementation compared to before (OR 0.43; 95% CI 0.075-2.45). MIGS clinic implementation appeared to increase the odds of having a minimally invasive hysterectomy (59% [47/80] before vs. 72% [242/336] after; OR 2.07; 95% CI 0.46-9.25) and decrease the odds of having an open hysterectomy (34% [27/80] vs. 14% [48/363]; OR 0.56, 95% CI 0.11-2.93), although these did not reach statistical significance. Myomectomy analysis was not performed due to low frequency of procedure performance in the before period.</div></div><div><h3>Conclusion</h3><div>Implementation of a MIGS clinic for patients without previous access led to a clinically meaningful decrease in composite complication rate, increased rate of minimally invasive hysterectomy, and decreased rate of open hysterectomy, although these findings were not statistically significant. A larger sample size is needed to further assess the impact of expanded MIGS access.</div></div>\",\"PeriodicalId\":16397,\"journal\":{\"name\":\"Journal of minimally invasive gynecology\",\"volume\":\"32 11\",\"pages\":\"Page S2\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-10-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of minimally invasive gynecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553465025003437\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of minimally invasive gynecology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553465025003437","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

研究目的本研究的目的是探讨微创妇科手术（MIGS）安全网临床实施对综合主要并发症发生率（术中和术后）的影响。设计：在实施MIGS安全网诊所之前（2018-2019年）和之后（2021-2024年），对接受肌瘤手术的患者进行回顾性研究。美国中西部学术性三级转诊医院。患者或参与者：416名在两个妇产科安全网诊所接受子宫切除术或子宫肌瘤切除术治疗症状性肌瘤的患者（80例为术前亚组，336例为术后亚组）。干预措施米格诊所安全网的实施。治疗前和治疗后患者平均年龄分别为44.2±7.3岁和42.8±7.0岁（p = 0.092）。大多数患者自我报告的种族为黑人，77.2%（321/416）和66.3%（273/416）生活在该国79% -100%最贫困的社区（根据邻里地图集区域剥夺指数衡量）。对不平衡基线协变量进行调整后的中断时间序列分段回归分析。治疗前和治疗后主要并发症发生率分别为28%（22/80）和13%（45/336）。与实施前相比，实施后发生主要并发症的几率降低了57% （OR 0.43; 95% CI 0.075-2.45）。临床实施MIGS似乎增加了微创子宫切除术的几率（术前59%[47/80]，术后72% [242/336]；OR 2.07; 95% CI 0.46-9.25），降低了开放性子宫切除术的几率（34%[27/80]对14% [48/363]；OR 0.56, 95% CI 0.11-2.93），尽管这些差异没有达到统计学意义。由于术前手术次数较少，未进行子宫肌瘤切除术分析。结论对未就诊的患者实施MIGS门诊，复合并发症发生率降低，微创子宫切除术率增加，开放式子宫切除术率降低，但无统计学意义。需要更大的样本量来进一步评估扩大MIGS准入的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Examining the Impact of a Minimally Invasive Gynecologic Surgery Safety-Net Clinic on Fibroid Surgery: A Retrospective before & after Study

Study Objective

The aim of this study was to examine the impact of implementing a minimally invasive gynecologic surgery (MIGS) safety-net clinic on composite major complication rate (intraoperative and postoperative).

Design

Retrospective before and after study examining patients undergoing fibroid surgery before (2018-2019) and after (2021-2024) implementation of a MIGS safety-net clinic.

Setting

Academic tertiary referral hospital in the Midwest United States.

Patients or Participants

416 patients cared for at two OB/GYN safety-net clinics who underwent hysterectomy or myomectomy for symptomatic fibroids (80 patients in the before and 336 in the after subgroup).

Interventions

Implementation of safety-net MIGs clinic.

Measurements and Primary Results

Average patient age was 44.2±7.3 before and 42.8±7.0 after (p 0.092). Majority of patients self-reported race as Black 77.2% (321/416) and 66.3% (273/416) live in the 79-100%ile most disadvantaged neighborhoods in the country (as measured by the Neighborhood Atlas Area Deprivation Index). Interrupted time series segmented regression analysis adjusting for unbalanced baseline covariates was performed. Composite major complications occurred in 28% (22/80) before vs. 13% (45/336) after. The odds of having a major complication was 57% lower after implementation compared to before (OR 0.43; 95% CI 0.075-2.45). MIGS clinic implementation appeared to increase the odds of having a minimally invasive hysterectomy (59% [47/80] before vs. 72% [242/336] after; OR 2.07; 95% CI 0.46-9.25) and decrease the odds of having an open hysterectomy (34% [27/80] vs. 14% [48/363]; OR 0.56, 95% CI 0.11-2.93), although these did not reach statistical significance. Myomectomy analysis was not performed due to low frequency of procedure performance in the before period.

Conclusion

Implementation of a MIGS clinic for patients without previous access led to a clinically meaningful decrease in composite complication rate, increased rate of minimally invasive hysterectomy, and decreased rate of open hysterectomy, although these findings were not statistically significant. A larger sample size is needed to further assess the impact of expanded MIGS access.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.