Laurel W. Rice

University of Wisconsin–Madison, Madison, Wisconsin, United States

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Publications (80)304.27 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To identify the pre-discharge predictors of 30-day readmission and the impact of same day discharge after laparoscopic hysterectomy. Patients undergoing only laparoscopic hysterectomy ± bilateral salpingo-oophorectomy. The 30-day readmission rate was 3.1% (277/8890).Factors predictive of higher rates of readmission were diabetes (4.4%vs 3.0%,p=0.03), chronic obstructive pulmonary disease (COPD) (8.5%vs 3.1%,p=0.02), disseminated cancer (20%vs 3.1%,p<0.001), chronic steroid use (7.1%vs 3.1%,p=0.03), daily alcohol use >2 drinks (12.5%vs 2.5%,p=0.04) and bleeding disorder (10.8%vs 3%,p=0.001). Operative factors included surgical time of greater than equal to 2 hours (3.5% vs. 2.7%,p=0.014). Post surgery, patients had a higher rate of readmission when they experienced any one or more complication prior to discharge, (6.9%vs.3.1%, p=0.01) as well as any complication after discharge (3.6%vs.1.6%, p=0.01). Infections (35.7%) and surgical complications (24.2%) were the most common reasons of readmissions. Of these patients, 20.9% were discharged the same day (n= 1855) and had similar rate of readmission (2.6% vs. 3.2%,p=n.s.). Laparoscopic hysterectomy readmission score (LHRS) can be calculated by assigning 1 point to diabetes, COPD, disseminated cancer, chronic steroid use, bleeding disorder, length of surgery >=2hrs and 2 points to any postoperative complication prior to discharge. Readmission rates for the LHRS score were score 1 (2.4%), score 2 (3.3%), score 3 (5.8%), score 4 (9.5%). Overall readmission rate after laparoscopic hysterectomy is low. Patients discharged the same day have similar rates of readmission. Higher LHRS is indicative of higher rates of readmission and may identify a population not suitable for same day discharge and in need of higher vigilance to prevent readmissions. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 05/2015; 213(3). DOI:10.1016/j.ajog.2015.05.014 · 4.70 Impact Factor
  • Gynecologic Oncology 04/2015; 137:151. DOI:10.1016/j.ygyno.2015.01.377 · 3.77 Impact Factor
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    ABSTRACT: To describe challenges faced by low-middle income countries (LMICs) across the cancer spectrum, with specific focus on gynecologic cancers. MEDLINE was searched for research articles published in English between January 1, 2000-February 1, 2015 which reported on global health efforts in LMICs. An estimated 80% of global cancer burden and only 5% of global cancer spending affects LMICs. The overwhelming majority of cervical cancer cases and related deaths occur in LMICs. The charge to close this cancer divide is at the center of global health efforts. Prevention is central to global health efforts to close the cancer divide. The gynecologic oncology community is well positioned to lead efforts in global health by partnering with institutions, professional societies and advocacy groups. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 03/2015; 137(2). DOI:10.1016/j.ygyno.2015.03.009 · 3.77 Impact Factor
  • Marcela G. del Carmen · Laurel W. Rice
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    ABSTRACT: In gynecologic oncology, significant advances with improved patient outcomes have clearly and thankfully resulted from randomized clinical trials. The recent restructuring of cooperative groups and decreased funding for phase III clinical trials have unintentionally resulted in a 90% reduction of available trials and accrual in gynecologic oncology. This Commentary reviews the history of the underrepresentation of women in clinical trials, highlighting the challenges that threaten the viability of gynecologic oncology clinical research, resulting in a decreased likelihood of improving the survival of women with gynecologic cancer. We suggest an opportunity for partnering with the U.S. government and the private sector to enhance research funding opportunities while increasing advocacy efforts to reinvigorate our clinical trials platform.
    Obstetrics and Gynecology 03/2015; 125(3):1. DOI:10.1097/AOG.0000000000000695 · 5.18 Impact Factor
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    ABSTRACT: Objective: The purpose of this study was to quantify the predictive value of frailty index on 30-day Clavien class IV (requiring critical care support) and class V (30-day mortality) complications after gynecologic cancer surgery. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) 2008-2011 had a final diagnosis of gynecologic malignancy. Modified frailty index (mFI) was calculated with 11 variables. Higher mFI scores indicated more severe comorbidities. Logistic regression was used to control for known predictors of complications. Results: Of the total 6551 patients, 188 (2.9%) of the patients experienced a Clavien IV/V complication. 2958 patients had a score of 0 (45.2%), 2405 patients had a score of 1 (36.7%), 985 patients had a score of 2 (15%), 162 patients had a score of 3 (2.5%) and 41 patients had a score≥4 (0.6%). The rates of Clavien IV/V complications were 2%, 2.7%, 4.4%, 7.4% and 24.4% for mFI scores of 0, 1, 2, 3 and ≥4, respectively (p<0.001). Variables found to be significant for predicting Clavien IV and V complications on logistic regression modeling were preoperative albumin<3g/dL (OR=6.5), operative time (OR=1.003 per min increase), non-laparoscopic surgery (OR=3.3), and frailty index (OR score 0=reference, score 1=1.26, score 2=1.9, score 3=2.33 and score≥4=12.5). Taking the two preoperative factors of albumin and mFI allowed for greater precision in identifying women who are at higher risk for requiring ICU care (>10% risk). Conclusions: Modified frailty index (mFI) is predictive of the need for critical care support and 30-day mortality after surgery for gynecologic cancer.
    Gynecologic Oncology 01/2015; 137(1). DOI:10.1016/j.ygyno.2015.01.532 · 3.77 Impact Factor
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    ABSTRACT: To evaluate a cohort of gynecologic oncology patients to discover risk factors for early- and late-occurring incisional hernia after midline incision for ovarian cancer. We collected retrospective data from patients undergoing primary laparotomy for ovarian cancer at the University of Wisconsin Hospitals and Clinics from 2001 to 2007. Patient characteristics and potential risk factors for hernia formation were noted. Physical examination, abdominal computerized assisted tomography scans, or both were used to detect hernias 1 year after surgery (early hernia) and 2 years after surgery (late hernia). There were 265 patients available for the 1-year analysis and 189 patients for the 2-year analysis. Early and late hernia formation occurred in 9.8% (95% confidence interval [CI] 6.2-12%) and an additional 7.9% (95% CI 4.1-12%) of patients, respectively. Using multiple logistic regression, poor nutritional status (albumin less than 3 g/dL) and suboptimal cytoreductive surgery (1 cm or greater residual tumor) were significantly associated with the formation of early incisional hernia after midline incision (P<.001 for both). Late hernia formation was associated only with age 65 years or older (P=.01). The formation of early incisional hernias after midline incision is associated with poor nutritional status and suboptimal cytoreductive surgery, whereas late hernia formation is associated with advanced age. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 01/2015; 125(2). DOI:10.1097/AOG.0000000000000610 · 5.18 Impact Factor
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    ABSTRACT: Objective: SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of <139 mL/dL and a primary outcome of the protocol's impact on SSI rates. Methods: We compared SSI rates retrospectively among three groups. Group 1 was composed of patients with DM whose blood glucose was controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI. Results: We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28-0.91) in reducing SSI rates after instituting this protocol. Conclusions: Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics.
    Gynecologic Oncology 09/2014; 136(1). DOI:10.1016/j.ygyno.2014.09.013 · 3.77 Impact Factor
  • Gynecologic Oncology 06/2014; 133:129. DOI:10.1016/j.ygyno.2014.03.338 · 3.77 Impact Factor
  • Gynecologic Oncology 06/2014; 133:25-26. DOI:10.1016/j.ygyno.2014.03.083 · 3.77 Impact Factor
  • Gynecologic Oncology 06/2014; 133:167. DOI:10.1016/j.ygyno.2014.03.441 · 3.77 Impact Factor
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    ABSTRACT: To quantify the impact of preoperative hypoalbuminemia on 30-day mortality and morbidity after gynecologic cancer surgery METHODS: Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent any non-emergent surgery for gynecologic malignancy between 1/1/2008 and 12/31/2010 were identified. Analysis was conducted with albumin both as a dichotomous variable (< 3.5g/dl was defined as low albumin) and as a continuous variable to determine a clinically relevant cut-off value. Of the total 3171 patients identified, 2110 had preoperative albumin levels available for analysis. In addition, 279 (13.3%) of these patients had low albumin levels. According to multivariate analysis, the low albumin group had significantly higher odds of developing one or more post-operative complications (OR-2,CI: 1.47-2.73, p<0.0001), three or more complications (OR-4.1,CI: 2.31-7.1, p<0.0001), surgical complications (OR-2.39,CI: 1.59-3.58, p<0.0001), thromboembolic complications (OR-2.59,CI: 1.33-5.06, p<0.0001), pulmonary complications (OR-4.06,CI: 2.05-8.03, p<0.0001), or infectious complications (OR-1.84,CI: 1.26-2.69, p<0.0001) and a higher 30-day mortality (OR-6.52,CI: 2.51-16.95, p<0.0001). Upon subgroup analysis, this difference was not found in patients undergoing laparoscopic surgery. In patients undergoing open surgery, the probability of experiencing one or more post-operative complications increased linearly with the decrease in albumin level; however, the probability of patients experiencing three or more complications and 30-day mortality increased sharply as soon as the albumin level decreased below 3g/dl. Preoperative albumin levels<3g/dL identify a population of patients at a very high-risk of experiencing perioperative morbidity and 30-day mortality after open surgery.
    Gynecologic Oncology 08/2013; 131(2). DOI:10.1016/j.ygyno.2013.08.011 · 3.77 Impact Factor
  • Gynecologic Oncology 07/2013; 130(1):e22. DOI:10.1016/j.ygyno.2013.04.114 · 3.77 Impact Factor
  • Gynecologic Oncology 03/2012; 125:S10. DOI:10.1016/j.ygyno.2011.12.020 · 3.77 Impact Factor
  • M Heather Einstein · Laurel W Rice
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    ABSTRACT: It is reasonable to perform complete lymphadenectomy in patients at significant risk of lymph node metastases, and use the results to guide adjuvant treatment decisions.(24,25) Criteria for staging based on intraoperative pathology should be determined in consultation with the pathologist, preferably with an institution-specific quality-assurance review.(34) Patients with more aggressive histologies should undergo a staging procedure including an omental biopsy whenever possible, with the understanding that most require systemic adjuvant therapy. Minimally invasive surgery is associated with shorter recovery and fewer postoperative complications than open endometrial cancer staging,(4,5,45) with preliminary data showing similar oncologic outcomes (Walker and colleagues, late breaking abstract SGO 2010 Annual Meeting). Whenever feasible, patients should be offered minimally invasive surgery for endometrial cancer staging. Retrospective data support an attempt at complete cytoreduction in patients with advanced endometrial cancer and a good performance status.(8-12) The decision to perform aggressive cytoreductive surgery should be individualized, taking into account the patient's comorbidities, her performance status, her symptoms, and the risks associated with more aggressive surgical procedures.
    Hematology/oncology clinics of North America 02/2012; 26(1):79-91. DOI:10.1016/j.hoc.2011.10.005 · 2.30 Impact Factor
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    ABSTRACT: Concerns have been raised about gynecologists as vaccinators. This survey evaluated use of the human papillomavirus (HPV) vaccine, attitudes, and barriers among gynecologists and family practitioners for differences between the 2 specialties. A cross-sectional survey was conducted using a 50-item, self-administered questionnaire mailed to participants. The study was conducted in Virginia through the University of Virginia Center for Survey Research. The questionnaire was mailed to 500 family practitioners and 500 gynecologists. The questionnaire asked provider and practice demographics, vaccine practices, knowledge, HPV vaccine attitudes, and barriers to vaccination. We compared gynecologists to family practitioners for the outcome of offering HPV vaccination. Logistic regression was performed to determine factors associated with providers choosing to offer and recommend the HPV vaccine. After exclusion of ineligible physicians, 385 of 790 doctors responded (48.7%). Seventy percent of family practitioners and 73.5% of gynecologists currently offer the HPV vaccine. There were no significant differences in demographics or practice patterns between the specialties. The most frequent barrier to vaccination reported by both groups was reimbursement. In multivariate logistic regression, inadequate reimbursement was negatively associated with offering the HPV vaccine (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.15-1.1) and with recommending the vaccine to patients (OR 0.45; 95% CI 0.26-0.76). Experience treating HPV- related disease was positively associated with offering the HPV vaccine (OR 2.3; 95% CI 1.1-4.8). Gynecologists are providing HPV vaccination at rates similar to family practitioners. Reimbursement concerns may negatively have an impact on doctors' recommendation of the HPV vaccine.
    Journal of pediatric and adolescent gynecology 09/2011; 24(6):380-5. DOI:10.1016/j.jpag.2011.06.016 · 1.68 Impact Factor
  • Laurel W Rice
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    ABSTRACT: The development of effective prevention strategies for breast, endometrial and ovarian cancers (CA), based on hormonal responsiveness, is a paramount opportunity in the care of women at risk for these malignancies. Breast CA prevention, utilizing Selective Estrogen Receptor Modulators (SERMs) is a well-established paradigm in the management of high risk women. Aromatase inhibitors (AI) and prophylactic bilateral salpingo-oophorectomy are presently under investigation for that same purpose. Endometrial carcinoma (EC), specifically Type 1, is the most common gynecologic malignancy in the United States. Its positive association with excess estrogen exposure provides significant opportunity for hormonal chemoprevention. Population-based studies have established that oral contraceptives (OC) significantly decrease the incidence of this malignancy. This risk reduction lasts up to 20 years after discontinuation of OCs. The association between elevated BMI and risk of developing EC (due to increased peripheral estrogen exposure) has prompted investigation into the role of weight reduction in EC prevention. The prevention of epithelial ovarian cancer (EOC) is of particular interest given its high mortality rate and the lack of a cost-effective screening program. OC usage significantly diminishes the incidence of EOC, in both the general population, as well as in patients with BRCA 1 or 2 mutations. Risk reduction is greatest with prolonged usage and persists for more than 30 years after OC use, but diminishes over time. Prospective, randomized trials, designed to control for all known variables, are mandatory to fully assess the potential for hormonal chemoprevention in breast, endometrial and ovarian cancers.
    Gynecologic Oncology 08/2010; 118(2):202-7. DOI:10.1016/j.ygyno.2010.03.014 · 3.77 Impact Factor
  • Source
    J Stuart Ferriss · Laurel W Rice
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    ABSTRACT: Epithelial ovarian cancer (EOC) continues to be the most lethal gynecologic malignancy. Efforts to personalize chemotherapy treatments by utilizing in vitro tumor assays to predict chemotherapeutic response have been tested in both the primary and recurrent treatment setting. To date, several retrospective studies have suggested improved response rates to predicted chemotherapeutic agents. However, a prospective, controlled trial merely found equivalence between in vitro prediction and empirical treatment selection. This review summarizes the current data regarding in vitro directed chemotherapy in EOC.
    Reviews in obstetrics and gynecology 01/2010; 3(2):49-54.
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    ABSTRACT: To examine the clinicopathologic features, progression-free interval, and survival of patients with grade 3 endometrioid endometrial cancer (G3 EEC) and malignant mixed müllerian tumors (MMMTs). Akt, epidermal growth factor receptor (EGFR), and HER-2/neu expression in these histologic subtypes was also investigated. Associations between phosphorylated Akt and clinicopathologic features were tested. One hundred nineteen women whose conditions were diagnosed with MMMT or G3 EEC from January 1, 1990, to December 31, 2003, met inclusion criteria. Retrospective data review was performed. In addition, Akt and EGFR protein expression was measured in tissue samples using Western blotting and immunohistochemistry. Fluorescence in situ hybridization was used to assay HER-2/neu gene amplification. Fifty-nine patients with MMMT and 60 patients with G3 EEC were identified. Patients with MMMT were older (P = 0.055), more likely to be African American (P = 0.049), have a family history of breast cancer (P = 0.039), have disease involving the uterine cervix (P = 0.007), and experience postoperative complications (P = 0.012). Patients with MMMT had a significantly shorter progression-free interval (23 vs 57 months, P = 0.001) and survival (55 vs 92 months, P = 0.001) than patients with G3 EEC.Grade 3 EEC and MMMT have significantly higher phospho-Akt levels than grade 1 EEC and normal controls. Phospho-Akt was associated with depth of myometrial invasion (r = 0.46, P = 0.05), but not with stage, lymph-vascular space invasion, or tumor size. The mesenchymal component of MMMT preferentially demonstrated EGFR expression relative to the epithelial component (45% vs 13%, P = 0.06). HER-2/neu amplification was observed in 1 of 37 samples. Improved therapy is warranted for both poorly differentiated EEC and MMMT. Recognition of similarities and differences between MMMT and other high-grade histologic types of uterine cancer may provide rationale for new treatment approaches possibly incorporating targeted biological therapies.
    International Journal of Gynecological Cancer 01/2009; 19(2):261-5. DOI:10.1111/IGC.0b013e31819a1fa5 · 1.95 Impact Factor
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    ABSTRACT: The purpose of the study was to implement a uniform system for assigning tumor grade in serous ovarian cancer and evaluate its correlation with response to conventional chemotherapy. Serous ovarian cancer tumor samples were retrospectively reviewed by 3 pathologists who were blinded to the original report. Samples were scored for architectural pattern, nuclear pleomorphism, and mitotic activity. Sum scores from these 3 indices were used to classify tumors as low grade or high grade. A total of 21 patients were identified as low-grade tumors and 21 were identified as high-grade tumors. Of low-grade tumors, 16 (76%) were found to be platinum resistant, defined as recurrent or persistent disease, 180 days from completion of the final cycle of chemotherapy, Of 21 patients defined as high grade, 9 (43%) were platinum resistant (P = .028). Utilization of a uniform grading system retrospectively correlates with platinum sensitivity.
    American journal of obstetrics and gynecology 06/2008; 199(2):189.e1-6. DOI:10.1016/j.ajog.2008.04.031 · 4.70 Impact Factor
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    ABSTRACT: Patients with stage IB2 cervical cancer at our institution are treated primarily with definitive chemoradiation, or chemoradiation followed by adjuvant hysterectomy. We sought to compare the cost differences associated with these two strategies. We identified all patients with stage IB2 cervical cancer who received their entire treatment regimen at our institution between 1995 and 2004. All patients received a combination of chemotherapy, external beam radiation, and one brachytherapy procedure, followed by either a second brachytherapy procedure or a simple hysterectomy. We retrieved cost data associated with hospitalization for the completion of respective treatment, including pharmacy, laboratory and pathology, radiation, and operating room services, as well as the costs of supplies and room and board. We identified 46 patients with stage IB2 cervical cancer, 23 who received a second brachytherapy procedure and 23 who underwent simple hysterectomy. Patients displayed similar demographics and similar disease characteristics including initial tumor diameter and histology. The cost of care for adjuvant hysterectomy group was greater ($8,316.70 vs 5,508.70, P < 0.0001). Specific differences included higher operating room costs ($1520 vs 414, P < 0.0001), pharmacy costs ($675 vs 342, P < 0.0001), and laboratory/pathology costs ($597 vs 89, P < 0.0001). We conclude that definitive chemoradiation appears to be associated with lower costs for management of stage IB2 cervical cancer when compared to simple adjuvant hysterectomy.
    International Journal of Gynecological Cancer 03/2008; 18(2):274-8. DOI:10.1111/j.1525-1438.2007.01007.x · 1.95 Impact Factor

Publication Stats

2k Citations
304.27 Total Impact Points


  • 2008–2015
    • University of Wisconsin–Madison
      • Department of Obstetrics and Gynecology
      Madison, Wisconsin, United States
  • 1996–2008
    • University of Virginia
      • • Department of Pathology
      • • Department of Obstetrics and Gynecology
      • • Division of Gynecologic Oncology
      Charlottesville, VA, United States
  • 2007
    • Gynecologic Oncology Group
      Buffalo, New York, United States
  • 1989–1996
    • Harvard Medical School
      • • Department of Pathology
      • • Department of Obstetrics, Gynecology, and Reproductive Biology
      Boston, Massachusetts, United States
  • 1995
    • National Cancer Institute (USA)
      베서스다, Maryland, United States
    • Virginia Mason Medical Center
      Seattle, Washington, United States
  • 1994
    • Tufts University
      Бостон, Georgia, United States
  • 1993
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1991–1992
    • Massachusetts General Hospital
      • Department of Pathology
      Boston, Massachusetts, United States