Publications by authors named "Megan N Wasson"

16 Publications

  • Page 1 of 1

Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida.

Gynecol Obstet Invest 2021 Oct 12:1-9. Epub 2021 Oct 12.

Division of Gynecologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.

Objectives: This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states.

Design: This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018.

Methods: Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum t tests for OMEs and χ2 t tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).

Results: In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (p < 0.0001). The opioid refill rate remained unchanged at 7.4% (p = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (p < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; p = 0.739).

Limitations: Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design.

Conclusions: Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.
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http://dx.doi.org/10.1159/000519517DOI Listing
October 2021

Ultrasound-guided Spinal Needle Localization for Resection of Abdominal Wall Endometrioma.

J Minim Invasive Gynecol 2021 05 23;28(5):929-930. Epub 2021 Jan 23.

Department of Gynecology (Drs. Misal and Wasson).

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http://dx.doi.org/10.1016/j.jmig.2021.01.014DOI Listing
May 2021

Surgical Decision Regret in Women Pursuing Surgery for Endometriosis or Chronic Pelvic Pain.

J Minim Invasive Gynecol 2021 07 24;28(7):1343-1350. Epub 2020 Sep 24.

Department of Gynecology (Drs. Misal and Wasson).

Study Objective: To identify incidence of decision regret associated with surgery for endometriosis or chronic pelvic pain (CPP).

Design: Survey study.

Setting: Academic medical center.

Patients: All patients undergoing excisional surgery for endometriosis or CPP between January 2016 and June 2019.

Interventions: The women were contacted to complete 2 validated questionnaires: the Decision Regret and Patient Global Impression of Improvement scales.

Measurements And Main Results: A total of 253 patients were contacted, and 154 patients responded (60.8% response rate) to the survey. A total of 137 women (90%) agreed or strongly agreed that having excisional surgery was the right decision; 134 women (87%) indicated that they would choose to have surgery again. The survey responders did not differ from nonresponders in age (years, 33.9 vs 35; p = .25), robotic route of surgery (83.1% vs 78.8%; p = .66), or performance of hysterectomy (27.3% vs 26.3%; p = .85). The responders were more likely to have stage III/IV endometriosis (50.6% vs 29.3%; p <.01), more previous surgeries for endometriosis (median surgeries, 1 vs 0; p = .01), higher complication rate (8.4% vs 2.0%; p = .03), and pathology test results more frequently positive for endometriosis (87.7% vs 77.8%; p = .03). Overall, 25 patients (16.3%) reported some level of regret after excisional surgery for endometriosis or CPP. Regret was not associated with a lower Patient Global Impression of Improvement score (odds ratio [OR] 4.37; 95% confidence interval [CI], 0.81-23.7), age (OR 0.98; 95% CI, 0.93-1.04), time since surgery (OR 1; 95% CI, 0.97-1.04), number of previous surgeries (OR 1.08; 95% CI, 0.9-1.31), negative pathology test results (OR 2.82; 95% CI, 0.95-8.32), hysterectomy (OR 1.23; 95% CI, 0.45-3.32), or complications (OR 1.07; 95% CI, 0.22-5.16).

Conclusion: Most women who pursue excisional surgery for endometriosis or CPP are satisfied with their decision. Regret was not associated with patient-reported lack of improvement, negative pathology test results, hysterectomy, or complications. Gynecologic surgeons should engage in shared decision-making with patients and feel comfortable offering surgical evaluation and management to patients with endometriosis or CPP when clinically indicated.
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http://dx.doi.org/10.1016/j.jmig.2020.09.016DOI Listing
July 2021

Cost-effective minimally invasive gynecologic surgery: emphasizing surgical efficiency.

Curr Opin Obstet Gynecol 2020 08;32(4):243-247

Department of Gynecology, Mayo Clinic Arizona, Phoenix, Arizona, USA.

Purpose Of Review: The United States has the highest healthcare costs among developed countries. This review evaluates surgical practices and equipment choices during endoscopic hysterectomy, highlighting opportunities for the gynecologic surgeon to reduce costs and maximize surgical efficiency.

Recent Findings: There are opportunities to economize at every step of the endoscopic hysterectomy. When surgeons are provided education about instrumentation costs, the cost of hysterectomy has been shown to decrease. Colpotomy has been found to be the rate-limiting step in laparoscopic hysterectomy; use of a uterine manipulator likely saves time and money. When evaluating the economic impact of route of surgery, the cost differential between laparoscopic and robotic-assisted hysterectomy has decreased. Robotic-assisted hysterectomy may be more cost-effective in some cases, such as for larger uteri. From a systems-level perspective, dedicating a specific operating room team to the gynecology service can decrease operative time.

Summary: The gynecologic surgeon is best equipped to control surgery-related costs by making choices that improve surgical efficiency and decrease operating room time. If a costlier piece of equipment leads to a more efficient case, the choice may be more cost-effective. There are multiple systems-level changes that can be implemented to decrease surgery-related costs.
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http://dx.doi.org/10.1097/GCO.0000000000000636DOI Listing
August 2020

Is Hysterectomy a Risk Factor for Urinary Retention? A Retrospective Matched Case Control Study.

J Minim Invasive Gynecol 2020 Nov - Dec;27(7):1598-1602. Epub 2020 Feb 28.

Department of Gynecology, Mayo Clinic Arizona, Phoenix, Arizona (Drs. Misal, Yang, and Wasson).

Study Objective: Compare the rates of urinary retention in patients undergoing endoscopic hysterectomy with those of patients undergoing nonhysterectomy endoscopic gynecologic surgery.

Design: Retrospective case control study matched by operative time.

Setting: Academic medical center.

Patients: All patients undergoing endoscopic gynecologic surgeries between January 2013 and December 2018.

Interventions: Outpatient endoscopic gynecologic surgery.

Measurements And Main Results: A total of 200 endoscopic hysterectomy cases were matched to endoscopic nonhysterectomy gynecologic surgery controls in a 1:1 ratio. The differences in baseline and operative characteristics between the 2 groups included age (48.6 years vs 45.7 years, p = .04), perioperative opioid administration (morphine milligram equivalents, 11.6 mg vs 7.6 mg, p = .01), and estimated blood loss (64.1 mL vs 31.8 mL, p = .001). The rate of urinary retention in the hysterectomy group was double that in the nonhysterectomy group (26.5% vs 13%, p = .01). In the hysterectomy group, age, perioperative opioids, operative time, and estimated blood loss did not differ between those who failed and those who passed the void trial. In the nonhysterectomy group, only operative time was significantly longer in those who failed the void trial (108 minutes vs 94.3 minutes, p = .04). After adjusting for perioperative opioid use and operative time, the relative risk of urinary retention in the hysterectomy group was 2.3 (p = .002, 95% confidence interval, 1.38-3.98).

Conclusion: Hysterectomy appears to be an independent and major factor contributing to postoperative urinary retention. When compared with nonhysterectomy gynecologic surgical controls with similar operative times, the rate of urinary retention in patients who underwent hysterectomy was doubled.
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http://dx.doi.org/10.1016/j.jmig.2020.02.010DOI Listing
February 2021

Chronic Pelvic Pain Caused by Postmenopausal Endometriosis.

Authors:
Megan N Wasson

J Minim Invasive Gynecol 2020 Mar - Apr;27(3):561-563. Epub 2019 Aug 20.

Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona. Electronic address:

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http://dx.doi.org/10.1016/j.jmig.2019.08.015DOI Listing
August 2019

Surgical Management and Prevention of Ovarian Remnant.

J Minim Invasive Gynecol 2019 Jul - Aug;26(5):811. Epub 2018 Nov 8.

Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona (all authors).

Study Objective: To provide surgeons with surgical techniques necessary for management and prevention of ovarian remnant syndrome.

Design: Instructional video (Canadian Task Force classification III).

Setting: Academic medical center.

Intervention: Surgical dissection and retroperitoneal anatomy.

Measurements And Main Results: Ovarian remnant syndrome occurs when residual ovarian tissue inadvertently remains in situ after salpingo-oophorectomy [1-4]. It can result in pelvic pain and pelvic mass [1-4]. Risk factors include endometriosis, adhesive disease, pelvic inflammatory disease, and prior pelvic surgery [1-4]. Ovarian remnant can also occur as a result of ovarian stroma extending up to 1.4 cm into the infundibulopelvic ligament beyond the visible margin [5]. Medical management and radiotherapy are treatment options but do not provide the definitive management that surgery affords [1-4]. Surgery also avoids missing a potential malignancy within the remnant tissue [1-4]. This video demonstrates the surgical techniques necessary to treat and prevent this condition, including key retroperitoneal anatomy. Mayo Clinic Institutional Review Board approval was not required for this video article.

Conclusion: Both treatment and prevention of ovarian remnant syndrome follow the same basic surgical principles, including high ligation of the infundibulopelvic ligament, retroperitoneal dissection, and excision of all peritoneum and tissue adherent to the ovary.
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http://dx.doi.org/10.1016/j.jmig.2018.10.021DOI Listing
January 2020

Feasibility of Oophorectomy at the Time of Vaginal Hysterectomy in Patients with Pelvic Organ Prolapse.

J Minim Invasive Gynecol 2019 Sep - Oct;26(6):1063-1069. Epub 2018 Oct 18.

Department of Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona (Dr. Wasson).

Study Objective: To determine the feasibility of oophorectomy at the time of vaginal hysterectomy in patients with pelvic organ prolapse and to define prognostic factors and perioperative morbidity associated with the procedure.

Design: A retrospective cohort study (Canadian Task Force classification II-2).

Setting: An academic medical center.

Patients: All women who underwent total vaginal hysterectomy for the treatment of pelvic organ prolapse over 5 years were considered for inclusion in the study.

Interventions: Total vaginal hysterectomy and concomitant pelvic organ prolapse repair with or without oophorectomy.

Measurements And Main Results: A total of 289 women underwent total vaginal hysterectomy with pelvic organ prolapse repair. Vaginal oophorectomy was attempted in 179 patients (61.9%). The procedure was successful in 150 patients (83.8%; 95% confidence interval [CI], 77.6%-88.9%). High ovarian location was the most commonly cited reason for the inability to perform a planned unilateral/bilateral oophorectomy (n = 24, 82.7%). Attempting oophorectomy vaginally was associated with an increased duration of surgery by 7.3 minutes (p = .03), an increased change in hemoglobin by 0.2 g/dL (p = .02), and a higher rate of readmission (7.3% vs 1.8%, p = .04). Multiple logistic regression showed that increasing age (odds ratio = 1.12; 95% CI, 1.05-1.20; p <.001) and body mass index (odds ratio = 1.17; 95% CI, 1.07-1.27; p<.001) were associated with an increased risk of vaginal oophorectomy failure. On univariate analysis, race (p = .64), parity (p = .39), uterine weight (p = .91), need for uterine morcellation (p=.21), presence of endometriosis (p=.66), prior cesarean section (p=.63), prior laparoscopy (p=.37), and prior open abdominal/pelvic surgery (p = .28) did not impact the likelihood of successfully performing oophorectomy.

Conclusion: In patients with pelvic organ prolapse, a planned oophorectomy at the time of vaginal hysterectomy can be successfully performed in the majority of cases. Greater age and body mass index are associated with an increased likelihood of failure.
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http://dx.doi.org/10.1016/j.jmig.2018.10.010DOI Listing
May 2020

Techniques for Preemptive Analgesia in Gynecologic Surgery.

J Minim Invasive Gynecol 2019 02 18;26(2):197. Epub 2018 Sep 18.

Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona (all authors).. Electronic address:

Study Objective: To provide surgeons with techniques for preemptive analgesia during minimally invasive gynecologic surgery. Postoperative pain management is an important component of patient care after gynecologic surgery. There have been numerous advances in pain management, including studies that show that preoperative administration of analgesics decreases postoperative pain scores and narcotic medication requirements [1-3]. However, there is limited information on the techniques for preemptive analgesia [4,5].

Design: An instructional video showing a variety of preemptive analgesia techniques and the corresponding neuroanatomy (Canadian Task Force classification III). Mayo Clinic Institutional Review Board approval was not required for this video article.

Setting: Academic Medical Center INTERVENTIONS: Relevant abdominopelvic neuroanatomy is reviewed. This is followed by a demonstration of the preemptive analgesia techniques based on neuroanatomy principles.

Conclusion: Techniques for preemptive analgesia are simple and effective. These tools can be used for patients undergoing gynecologic surgeries via a vaginal or abdominal approach and can help optimize postoperative pain and narcotic usage.
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http://dx.doi.org/10.1016/j.jmig.2018.09.768DOI Listing
February 2019

Isolated Fallopian Tube Torsion Presenting as Acute Pelvic Pain.

J Minim Invasive Gynecol 2018 Nov - Dec;25(7):1122-1123. Epub 2017 Dec 27.

Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona.

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http://dx.doi.org/10.1016/j.jmig.2017.12.015DOI Listing
July 2019

Screening Women at High Risk for Cervical Cancer: Special Groups of Women Who Require More Frequent Screening.

Mayo Clin Proc 2017 08;92(8):1272-1277

Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ.

The updated cervical cancer screening guidelines recommend that women at average risk who have negative screening results undergo cervical cytological testing every 3 to 5 years. These recommendations do not pertain to women at high risk for cervical cancer. This article reviews recommendations for cervical cancer screening in women at high risk.
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http://dx.doi.org/10.1016/j.mayocp.2017.06.007DOI Listing
August 2017

Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial.

Fertil Steril 2017 Apr 24;107(4):996-1002.e3. Epub 2017 Feb 24.

Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address:

Objective: To determine whether the use of the robot for surgical treatment of endometriosis is better than traditional laparoscopy in terms of operative length, perioperative parameters, and quality of life outcomes.

Design: Multicenter, randomized clinical trial.

Setting: University teaching hospitals.

Patient(s): Women aged >18 years with suspected endometriosis who elected to undergo surgical management.

Intervention(s): Randomization to conventional or robot-assisted laparoscopic removal of endometriosis.

Main Outcome Measure(s): The primary outcome measured was operative time. Secondary outcomes were perioperative complications and quality of life.

Result(s): The mean operative time for robotic vs. laparoscopic surgery for endometriosis was 106.6 ± 48.4 minutes vs. 101.6 ± 63.2 minutes. There were no differences in blood loss, intraoperative or postoperative complications, or rates of conversion to laparotomy in the two arms. Both groups reported significant improvement on condition-specific quality of life outcomes at 6 weeks and 6 months.

Conclusion(s): There were no differences in perioperative outcomes between robotic and conventional laparoscopy.

Clinical Trial Registration Number: NCT01556204.
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http://dx.doi.org/10.1016/j.fertnstert.2016.12.033DOI Listing
April 2017

Morcellation and the Incidence of Occult Uterine Malignancy: A Dual-Institution Review.

Int J Gynecol Cancer 2016 Jan;26(1):149-55

*Department of Obstetrics and Gynecology, Christiana Hospital, Newark, DE; †Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, AZ; and ‡Division of Gynecologic Oncology, St. Luke's University Health Network, Bethlehem, PA; §Division of Gynecologic Oncology, Christiana Hospital, Newark, DE.

Objectives: To determine the incidence of unsuspected uterine sarcoma (UtSarc), other uterine malignancies, and potential malignancies at the time of hysterectomy or myomectomy using power morcellation.

Methods: We performed a retrospective cohort study of all women undergoing myomectomy or hysterectomy using power morcellation at 2 institutions between January 1, 2004, and May 31, 2015. The primary outcome was the incidence of uterine malignancy (UM). The predefined secondary outcome was the occurrence of other conditions associated with malignant behavior. For analysis, any UtSarc or endometrial cancer was categorized as a "uterine malignancy," whereas other pathologies with cytologic atypia were categorized as "uterine premalignant disease" (UPM). All other pathological results were classified as "nonmalignant."

Results: A total of 1004 women underwent hysterectomy or myomectomy using power morcellation during the studied period. Two women (1/502; 95% confidence interval [CI], 1/4144-1/139) were found to have UM pathology, 2 endometrial carcinomas and none with UtSarc (97.5% CI, 0-1/273). Six (1/167; 95% CI, 1/455-1/77) women were found to have UPM on final pathology: 2 atypical leiomyomas, 1 STUMP (smooth muscle tumors of uncertain malignant potential), and 3 endometrial atypical hyperplasias. Women with UM had uteri that weighed more than those with NM pathology (840 g vs 217.7 g, P = 0.028), and this trend was also seen with UM and UPM (435.0 g vs 217.2 g, P = 0.081). Women with UM and UPM were more likely to have a preoperative surgical indication of "uterine leiomyoma" compared with other benign etiologies (P < 0.001).

Conclusions: Among this cohort, all cases of unsuspected UM at the time of myomectomy or hysterectomy using power morcellation were found to be endometrial carcinoma. Unsuspected UM pathology had an incidence of 1 of 502. Factors associated with increased likelihood of UM or UPM were greater uterine weight and leiomyoma as the surgical indication.
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http://dx.doi.org/10.1097/IGC.0000000000000558DOI Listing
January 2016

Impact of a robotic surgical system on hysterectomy trends.

Del Med J 2015 Feb;87(2):45-50

Objective: To determine the impact of introduction of a robotic surgical system on hysterectomy trends.

Methods: A retrospective, cohort study using longitudinal medical records from a tertiary care community hospital was used to determine the surgical approach to hysterectomy. For the purposes of analysis, surgical approaches were categorized as robotically assisted, laparoscopic, laparotomy, vaginal, or laparoscopically assisted vaginal.

Results: A total of 4,440 women underwent a hysterectomy between January 2007 and December 2012 (benign gynecology N = 3,127, gynecologic oncology N = 1,001, urogynecology N = 312). Amongst benign gynecologists, during the five years following introduction of the robotic system, the rate of hysterectomy performed via laparotomy decreased from 62.2 percent to 39.1 percent, p-value < 0.001. The rate of robotically assisted hysterectomy increased from 0.0 percent to 26.4 percent, p-value < 0.001. When subspecialties were examined, the rate of hysterectomy performed by a gynecologic oncologist via laparotomy decreased from 89.7 percent to 20.0 percent, p-value < 0.001. The rate of robotically assisted hysterectomy increased from 0.0 percent to 78.3 percent, p-value < 0.001. Amongst urogynecologists, the rate of hysterectomy performed vaginally decreased from 80.0 percent to 33.6 percent, p-value < 0.001, while the rate of robotically assisted hysterectomy increased from 0.0 percent to 54.2 percent, p-value < 0.001.

Conclusions: The percentage of robotically assisted hysterectomies has dramatically increased and is now the primary modality for performing hysterectomy amongst subspecialists.
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February 2015

Developmental and persistent developmental stuttering: an overview for primary care physicians.

J Am Osteopath Assoc 2011 Oct;111(10):576-80

Lehigh Valley Health Network, Department of Emergency Medicine, 2604 Schoenersville Rd, Bethlehem, PA 18017-3518, USA.

Stuttering is a speech disorder characterized by a disruption in the fluency, timing, and rhythm of normal speech. It affects approximately 5% of children at some point in their lives. Although dysfluency often resolves before adulthood, it may cause periods of extreme anxiety for patients, especially those who continue to stutter in adolescence and adulthood. Although these patients are unlikely to stop stuttering, treatment options are available to reduce anxiety and therefore the severity of symptoms. In the present review article, the authors discuss the pathophysiology, diagnosis, and management of developmental stuttering in children and adults.
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October 2011

Pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia.

J Am Osteopath Assoc 2010 Jan;110(1):16-20

Lake Erie College of Osteopathic Medicine, Pennsylvania, USA.

Dapsone is a leprostatic agent commonly prescribed for the treatment of patients with leprosy, malaria, and a variety of blistering skin diseases, including dermatitis herpetiformis. Methemoglobinemia, a potentially life-threatening condition in which the oxygen-carrying capacity of blood in body tissues is reduced, is a known adverse effect of dapsone use. The authors report a case of dapsone-induced methemoglobinemia observed in the emergency department during routine workup for contact dermatitis in a patient with celiac disease. The pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia are discussed.
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January 2010
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