Michaela E McGree

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (151)625.55 Total impact

  • No preview · Article · Jan 2016 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: The obstetrics Adverse Outcomes Index was designed to measure the quality of perinatal care and includes ten adverse events that may occur at or around the time of delivery. We hypothesized that adverse outcomes on labor and delivery, including hypoxic ischemic encephalopathy, could be decreased with a combination of interventions, even among high-risk pregnancies.
    No preview · Article · Jan 2016 · American journal of obstetrics and gynecology
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    ABSTRACT: Objectives: To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion. Methods: Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter>2cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive. Results: Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95% CI, 92.4-97.5) and 96.8% (95% CI, 95.2-98.5), respectively. Conclusions: Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.
    No preview · Article · Dec 2015 · Gynecologic Oncology
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    ABSTRACT: Background: Many women have heavy menstrual bleeding during perimenopause that may interfere with overall quality of life and contribute to sexual dysfunction. We aimed to determine whether sexual function in women improves after endometrial ablation for heavy menstrual periods. Methods: Validated surveys (Female Sexual Function Index [FSFI], Female Sexual Distress Scale [FSDS], and Short-Form Health Survey [SF-12]) were administered to 136 women before and after endometrial ablation from August 2008 through June 2013. Scores at baseline and 6 months after surgery were compared using the paired t test. Results: A total of 97 women completed the FSFI and FSDS surveys at baseline and 6 months after ablation. Mean full-scale FSFI score increased from 26.5 to 28.8 (p < .001), with improvement in 5 of 6 FSFI domains. Mean FSDS score decreased from 13.6 to 9.7 (p < .001), showing decreased personal distress regarding sexual function. In assessing quality of life, SF-12 scores improved for global physical function (p < .001) and mental function (p = .002). Conclusions: Female sexual function improved and personal distress associated with sexual function decreased after endometrial ablation for heavy menstrual cycles.
    No preview · Article · Nov 2015 · Journal of Women's Health
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    ABSTRACT: Objectives: To refine models to predict surgical morbidity and 90-day mortality after primary debulking surgery (PDS) for advanced epithelial ovarian cancer (EOC). Methods: Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, and vital status were abstracted. Complications were graded using the Accordion classification. Nomograms were generated based on multivariate modeling. Results: 138 (22.3%) of the 620 patients who underwent PDS experienced a grade≥3 complication. Age (OR 1.21 per 10years increase in age), BMI (OR 1.35 for BMI<25kg/m(2) versus reference, OR 2.83 for BMI≥40kg/m(2) versus reference), ASA score≥3 (OR 1.49), stage (OR 1.69 stage IV) and surgical complexity (OR 2.32 high complexity versus intermediate) were predictive of an accordion grade≥3 complication Within 90days of surgery, 55 (8.9%) patients died. A multivariable model included age (OR 1.76 per 10year increase in age), ASA score≥3 (OR 3.28), preoperative albumin<3.5 (OR 4.31), and BMI (OR 2.04 for BMI<25kg/m(2) versus reference, OR 3.64 for BMI≥40kg/m(2) versus reference) was predictive of 90-day mortality. Conclusion: Using an independent cohort we report the importance of age, ASA score, preoperative albumin, FIGO stage, and surgical complexity, and BMI, to refine a prediction model for complications after PDS for advanced EOC. This information is useful in preoperative counseling and can be utilized to aid in patient-centered decision making and risk stratification.
    No preview · Article · Nov 2015 · Gynecologic Oncology
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    ABSTRACT: Objective: To identify independent risk factors for cesarean delivery after induction of labor and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing induction of labor at term. Methods: This is a retrospective cohort study including nulliparous women with singleton, term (37 0/7 weeks of gestation or greater), cephalic pregnancies undergoing induction of labor from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using International Classification of Diseases, 9th Revision codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. Results: During the study period, there were 785 nulliparous inductions that met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation less than 3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% confidence interval 0.671-0.750). Conclusion: We identified independent risk factors that can be used to predict cesarean delivery among nulliparous women undergoing induction of labor at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors. Level of evidence: II.
    No preview · Article · Oct 2015 · Obstetrics and Gynecology

  • No preview · Article · Oct 2015 · Journal of the American College of Surgeons
  • J. Janco · Amanika Kumar · Michaela E. McGree · Amy L. Weaver · William A. Cliby
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    ABSTRACT: Objectives: Determine the predictive value of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score, and prognostic factors for survival, in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer in a high-volume U.S. center. Methods: Medical records of women undergoing SCS between 12/1/1998 and 12/31/2013 were reviewed. Women with no gross residual disease (RD0) at primary surgery, ECOG performance status (PS) ≤1 at recurrence, and no ascites on CT at recurrence were classified as AGO score positive. Women with incomplete information to determine the AGO score were excluded. Overall survival (OS) and progression-free survival (PFS) following SCS, respectively, were estimated from multivariable Cox proportional hazards models. Results: 192 women met inclusion criteria. Median disease-free interval (DFI) was 1.9years (IQR, 1.0-3.5). Of the 102 (53.1%) AGO score positive cases, 84.3% (95% CI, 77.3-91.4%) achieved RD0 at SCS. However, 64.4% of AGO score negative cases also reached RD0. Patients with RD0 after SCS survived longer (median OS, 5.4years) vs. RD ≤1cm (2.4years) vs. RD >1cm (1.3years) (p<0.001). Median PFS was also longer in patients with RD0 (1.5years) vs. RD ≤1cm (0.9years) vs. RD >1cm (1.0years) (p=0.001). Among those with RD0 at SCS, AGO score was not associated with survival benefit, however, number of disease sites at recurrence, ECOG PS at recurrence, and DFI were associated with OS and PFS. Conclusions: AGO score can identify patients with a high likelihood of complete secondary cytoreduction and improved survival. However, most AGO score negative cases were also completed resected at SCS. Additional refinement of the score is needed to exclude women from SCS.
    No preview · Article · Oct 2015 · Gynecologic Oncology
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    ABSTRACT: To determine what proportion of a geographically defined population who receive new opioid prescriptions progresses to episodic or long-term patterns of opioid prescribing and to explore the clinical characteristics associated with patterns of opioid prescribing. Population-based drug prescription records for the population of Olmsted County between January 1 and December 31, 2009, were obtained using the Rochester Epidemiology Project medical records linkage system (N=142,377). All medical records were reviewed for a random sample of 293 patients who had a new ("incident") prescription for an opioid analgesic in 2009. Patients were followed through their medical records for 1 year after their initial prescription date, with patterns of opioid prescribing categorized as short-term, episodic, or long-term. Overall, 293 patients received 515 new opioid prescriptions in 2009. Of these, 61 (21%) progressed to an episodic prescribing pattern and 19 (6%) progressed to a long-term prescribing pattern. In multivariable logistic regression analyses, substance abuse was significantly associated (P<.001) with a long-term opioid prescribing pattern as compared with an short-term opioid prescribing pattern. Past or current nicotine use (P=.03) and substance abuse (P=.04) were significantly associated with an episodic or long-term prescribing pattern as compared with a short-term prescribing pattern. Knowledge of the clinical characteristics associated with the progression of a short-term to an episodic or long-term opioid prescribing pattern could aid in the identification of at-risk patients and provide the basis for developing targeted clinical interventions. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Mayo Clinic Proceedings
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    ABSTRACT: To construct a tool, using computed tomography (CT) imaging and preoperative clinical variables, to estimate successful primary cytoreduction for advanced epithelial ovarian cancer (EOC). Women who underwent primary cytoreductive surgery for stage IIIC/IV EOC at Mayo Clinic between 1/2/2003 and 12/30/2011 and had preoperative CT images of the abdomen and pelvis within 90 days prior to their surgery available for review were included. CT images were reviewed for large-volume ascites, diffuse peritoneal thickening (DPT), omental cake, lymphadenopathy (LP), and spleen or liver involvement. Preoperative factors included age, body mass index (BMI), Eastern Cooperative Oncology Group performance status (ECOG PS), American Society of Anesthesiologists (ASA) score, albumin, CA-125, and thrombocytosis. Two prediction models were developed to estimate the probability of (i) complete and (ii) suboptimal cytoreduction (residual disease (RD) >1 cm) using multivariable logistic analysis with backward and stepwise variable selection methods. Internal validation was assessed using bootstrap resampling to derive an optimism-corrected estimate of the c-index. 279 patients met inclusion criteria: 143 had complete cytoreduction, 26 had suboptimal cytoreduction (RD > 1 cm), and 110 had measurable RD ≤1 cm. On multivariable analysis, age, absence of ascites, omental cake, and DPT on CT imaging independently predicted complete cytoreduction (c-index = 0.748). Conversely, predictors of suboptimal cytoreduction were ECOG PS, DPT, and LP on preoperative CT imaging (c-index = 0.685). The generated models serve as preoperative evaluation tools that may improve counseling and selection for primary surgery, but need to be externally validated. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Apr 2015 · Gynecologic Oncology
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    ABSTRACT: To reexamine the tenet that advanced age independently impacts progression-free and cause-specific survival in patients with endometrial cancer (EC). Patients undergoing surgery for stage I-IIIC EC between 1999 and 2008 were stratified by age (<70 vs ≥70 years). Three propensity score (PS) methods were utilized to adjust for confounding risk factors. The PS, or conditional probability of being ≥70 years old, given a patient's baseline covariates, was derived using logistic regression. Cox proportional hazards models were fit to estimate the effect of age ≥70 on outcomes. Of 1,182 eligible patients, 822 (69.5%) were <70 and 360 (30.5%) were ≥70. Patients ≥70 were more likely to have multiple adverse risk factors. The total standardized difference of these factors was reduced by 74% and 81%, respectively, using PS-stratification and PS-matching analyses. The nonsignificant trend toward an association between progression-free survival and age ≥70 in unadjusted analysis (hazard ratio [HR], 1.40; 95% CI, 0.95-2.04) was further attenuated in the 3 PS analyses. The unadjusted HR for the association between age ≥70 and cause-specific survival was 2.03 (95% CI, 1.32-3.13). HRs were attenuated in PS analyses but retained significance (except for PS matching), potentially reflecting differences in salvage therapies (P<.001), including a 3-fold greater use of chemotherapy in those <70. When risk-adjusted for the higher prevalence of adverse prognostic factors in elderly EC patients, progression-free survival after primary therapy is not age dependent but the less favorable cause-specific survival in this cohort may reflect age-related postrecurrence treatment differences. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Apr 2015 · Gynecologic Oncology

  • No preview · Article · Apr 2015 · Gynecologic Oncology

  • No preview · Article · Apr 2015 · Gynecologic Oncology

  • No preview · Article · Apr 2015 · Gynecologic Oncology
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    ABSTRACT: Objective: To examine the influence of diabetes and metformin therapy on overall survival (OS) and progression-free survival (PFS) in patients with endometrial cancer (EC) by using propensity score (PS) matching to account for confounding factors. Methods: We retrospectively identified consecutive patients with stage I-IV EC managed surgically from 1999 through 2008 and stratified patients by diabetes status. PS matching was used to adjust for confounding covariates. OS and PFS were compared between diabetic and nondiabetic matched pairs and between matched pairs of diabetic patients with or without metformin therapy. Cox proportional hazards models were fit to estimate the effects on outcomes. Results: Among 1303 eligible patients (79% stage I, 28% grade 3), 277 (21.3%) had a history of diabetes. Among diabetic patients, treatment consisted of metformin in 116 (41.9%); 57 (20.6%) had other oral agents, 51 (18.4%) insulin with or without other oral agents, and 53 (19.1%) diet modification only. For PS-matched diabetic and nondiabetic patients with EC, OS (hazard ratio [HR], 1.01; 95% CI, 0.72-1.42) and PFS (HR, 1.01; 95% CI, 0.60-1.69) were similar between matched subsets. No differences in OS and PFS were observed when comparing PS-matched metformin users with nondiabetic patients (OS HR, 1.03; 95% CI, 0.57-1.85; PFS HR, 1.14; 95% CI, 0.49-2.62) or with other diabetic patients (OS HR, 0.61; 95% CI, 0.30-1.23; PFS HR, 1.06; 95% CI, 0.34-3.30). Conclusions: When adjusted for confounding covariates, OS and PFS are similar between diabetic and nondiabetic patients with EC and between metformin users and nonusers or nondiabetic patients.
    No preview · Article · Apr 2015 · Gynecologic Oncology

  • No preview · Article · Apr 2015 · Gynecologic Oncology

  • No preview · Article · Mar 2015 · Journal of Minimally Invasive Gynecology
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    ABSTRACT: To identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery. Patients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection. In total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18-2.89; P = 0.007), ascites [1.76 (1.11-2.81); P = 0.02], and postoperative complications during initial admission [grade 3-5 vs none, 2.47 (1.19-5.16); grade 1 vs none, 2.19 (0.98-4.85); grade 2 vs none, 1.28 (0.74-2.21); P = 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07-4.33; P = 0.04). Clinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.
    No preview · Article · Feb 2015 · International Journal of Gynecological Cancer
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    ABSTRACT: Our objective was to understand the relationship between optimal diabetes control, as defined by Minnesota Community Measurement (MCM), and adverse health outcomes including emergency department (ED) visits, hospitalizations, 30-day rehospitalization, intensive care unit (ICU) stay, and mortality. In 2009, we conducted a retrospective cohort study of empaneled Employee and Community Health patients with diabetes mellitus. We followed patients from 1 September 2009 until 30 June 2011 for hospitalization and until 5 January 2014 for mortality. Optimal control of diabetes mellitus was defined as achieving the following three measures: low-density lipoprotein (LDL) cholesterol <100 mg/mL, blood pressure <140/90 mmHg, and hemoglobin A1c <8%. Using the electronic medical record, we assessed hospitalizations, ED visits, ICU stays, 30-day rehospitalizations, and mortality. The chi-square or Wilcoxon rank-sum tests were used to compare those with and without optimal control. We used Cox proportional hazard models to estimate the associations between optimal diabetes mellitus status and each outcome. We identified 5,731 empaneled patients with diabetes mellitus; 2,842 (49.6%) were in the optimal control category. After adjustment, we observed that non-optimally controlled patients had higher risks for hospitalization (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00-1.23), ED visits (HR 1.15; 95% CI 1.06-1.25), and mortality (HR 1.29; 95% CI 1.09-1.53) than diabetic patients with optimal control. No differences were observed in ICU stay or 30-day rehospitalization. Diabetic patients without optimal control had higher risks of adverse health outcomes than those with optimal control. Patients with optimal control defined by the MCM were associated with decreased morbidity and mortality.
    Full-text · Article · Jan 2015 · Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
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    ABSTRACT: Surgical site infection (SSI) following epithelial ovarian cancer (EOC) primary surgery (PS) occurs in 10-15% of women. Perioperative factors associated with SSI and impact of SSI on survival were determined. EOC cases that underwent PS from 1/2/2003-12/30/2011 were retrospectively reviewed. SSIs were defined according to ACS NSQIP. Logistic regression models were fit to identify factors associated with SSI. Cox proportional hazards models were utilized to evaluate the association of patient and perioperative characteristics with overall survival (OS) and disease-free survival (DFS). Among 888 cases, 96 (10.8%) developed SSI: 32 superficial, 2 deep, and 62 organ/space. Factors independently associated with superficial SSI were increasing BMI (odds ratio 1.41 [95% confidence interval, 1.12, 1.76] per 5kg/m(2)), increasing operative time (1.24 [1.02, 1.50] per hour), and advanced stage (III/IV) (10.22 [1.37, 76.20]). Factors independently associated with organ/space SSI were history of gastroesophageal reflux disease (2.13 [1.23, 3.71]), surgical complexity (intermediate 3.11 [1.02, 9.49]; high 8.07 [2.60, 25.09]; referent: low), and residual disease (RD) (measureable ≤1cm 1.77 [0.96, 3.27]; suboptimal >1cm (3.36 [1.48, 7.61]; referent: microscopic). Occurrence of superficial (hazard ratio 1.69 [1.12, 2.57]) or organ/space (1.46 [1.07, 2.00]) SSI was independently associated with worse OS. SSI occurrence was not independently associated with DFS. SSI after PS is associated with decreased OS. Most risk factors for SSI are not modifiable. Alternative measures to lower rates of SSIs are needed as this may improve OS. Preoperative identification of SSI risk factors may assist in risk-assessment and operative planning. Copyright © 2014. Published by Elsevier Inc.
    No preview · Article · Dec 2014 · Gynecologic Oncology

Publication Stats

2k Citations
625.55 Total Impact Points


  • 2004-2015
    • Mayo Clinic - Rochester
      • • Department of Obstetrics & Gynecology
      • • Department of Health Science Research
      • • Department of Internal Medicine
      Рочестер, Minnesota, United States
  • 2011
    • University of Michigan
      • Department of Urology
      Ann Arbor, Michigan, United States
  • 2008-2009
    • Permanente Medical Group
      Pasadena, California, United States