Perioperative Management of Gynecological Surgery Patients: Does Fellow Involvement Improve Performance?

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2012 Nov 16

PMID 23152051

Authors

Holly L Steiner

Catrina C Crisp

Rachel N Pauls

Affiliations

Soon will be listed here.

Abstract

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.

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