Journal Club Obstetrics & Gynecology

1

2012 The American College of Obstetricians and Gynecologists www.greenjournal.org

Predictors of Successful Surgical Outcome in Laparoscopic Hysterectomy (Andries R. Twijnstra, MD, Mathijs D. Blikkendaal, MD, Erik W. van Zwet, PhD, Paul J. M. van Kesteren, MD, PhD, Cor D. de Kroon, MD, PhD, and Frank Willem Jansen, MD, PhD) April 2012 Volume 119 Issue 4 7008 Click Here to Read the Full Article 1. Review how the authors identified every gynecologist in the Netherlands who performed

laparoscopies. Not all of the eligible gynecologists participated in the study. Discuss possible reasons for non-participation. Would any of these reasons bias the results of the study or affect the generalizability of the conclusions?

2. Explore the strengths and weaknesses of the authors use of a voluntary registry for collecting data for this study. List and discuss the measures the authors employed to gather a complete set of data from the participating surgeons. Identify other voluntary registries that collect data on a large scale, such as the SART Registry or the FIBROID Registry, and study the techniques they use to ensure accuracy and completeness.

3. Review the authors method of estimating the Surgical Skills Factor (SSF). What conditions or circumstances might affect the SSF with regard to outcomes such as blood loss, operative time, or adverse events?

4. Review the main outcome measures. How were the outcomes determined for each hysterectomy? Which outcome is likely to be the most accurate? Which is likely to be the least accurate? How were the thresholds for successful surgery derived? Does dichotomization of continuous outcome measures reduce the impact of their inherent inaccuracy?

5. Consider the number of covariates used in the authors multivariable analysis. Compare the number of covariates with the number of unsuccessful surgical outcomes. Discuss whether there is a sufficient number of observations to allow for multivariable analysis.

6. Why did the authors use odds ratios rather than relative risks? For this analysis, which is preferable?

7. In Wallenstein MR, Ananth CV, Kim JH, Burke WM, Hershman DL, Lewin SN, et al. Effect of surgical volume on outcomes for laparoscopic hysterectomy for benign indications. Obstet Gynecol 2012;119:70916, also in this issue of the Green Journal, the authors report that surgeons performing a higher number of laparoscopic hysterectomies encounter fewer adverse events than surgeons with a lower number. Discuss possible explanations for this apparent disagreement with the Twijnstra report.

http://journals.lww.com/greenjournal/Fulltext/2012/04000/Predictors_of_Successful_Surgical_Outcome_in.3.aspxhttp://journals.lww.com/greenjournal/Fulltext/2012/04000/Effect_of_Surgical_Volume_on_Outcomes_for.4.aspxhttp://journals.lww.com/greenjournal/Fulltext/2012/04000/Effect_of_Surgical_Volume_on_Outcomes_for.4.aspxhttp://journals.lww.com/greenjournal/Fulltext/2012/04000/Effect_of_Surgical_Volume_on_Outcomes_for.4.aspx

Journal Club Obstetrics & Gynecology

2

2012 The American College of Obstetricians and Gynecologists www.greenjournal.org

8. Imagine that your Journal Club participants comprise a hospital credentials and privileging committee. After reading this paper and the accompanying editorial by Dr. Levy , what information will the committee require for granting privileges for laparoscopic hysterectomy? For maintenance of privileges for laparoscopic hysterectomy? Review the chapter, Assessing Clinical Competence, (Part 3) of the American College of Obstetricians and Gynecologists publication, Quality and Safety in Womens Health Care. What changes, if any, would you make in the Granting Privileges section?

http://journals.lww.com/greenjournal/Fulltext/2012/04000/Experience_Counts.1.aspxhttp://www.acog.org/Resources_And_Publications/Quality_and_Safety_in_Womens_Health_Care

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