Perioperative management of gynecological surgery patients: does fellow involvement improve performance?

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.

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.

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).

Fellow contributions toward clinical decisions resulted in more appropriate DVT prophylaxis and antibiotic administration prior to gynecological surgery.