Kristen A. Gerjevic, MD, MPH

Department

Obstetrics & Gynecology

Position

Assistant Professor

Articles

• Urogynecology
  Sripad AA,, Gerjevic KA, Duong V, Askew A, Clark SG, Woodburn KL, Maetzold E, Raker CA, Rardin CA Risk of Recurrent Prolapse by Extent of Mesh Excisions Procedures: A Multicenter Study Importance There is limited evidence guiding surgeons in how much mesh to resect when treating mesh complications. Objective The aim of the study was to compare rates of recurrent prolapse after mesh excisional surgical procedures for prolapse mesh complications. Study Design This multicenter, retrospective cohort study included patients, identified by Current Procedural Terminology codes, who were treated surgically for prolapse mesh complications at 8 institutions between 2010 and 2019. Excisional surgical procedures were categorized as major (total vaginal, extravaginal, and total mesh excisions) or minor (partial vaginal excisions and mesh revisions). The primary outcome was prolapse recurrence 1 year after mesh excision surgery. Secondary outcomes included long-term prolapse recurrence. Prolapse recurrence was evaluated by Kaplan-Meier survival analysis and Cox proportional hazards regression. Results Two hundred sixty-one patients met inclusion criteria with 188 (72%) undergoing minor and 73 (28%) major excisions, with a median follow-up time of 1.0 years. Groups differed in parity, location of implant surgery, and number of vaginal compartments involved in excision. Within the first year, major excisions had a higher prolapse recurrence rate (8.7%) than minor excisions (2.9%), P < 0.05. Adjusting for mesh implant type, the hazard ratio for pelvic organ prolapse was 6.1 in the major compared to minor excision. In the entire study period, prolapse recurrence was 33.8% and did not differ between groups. Conclusions Patients undergoing major excision surgical procedures may have higher rates of prolapse at 1 year compared to those undergoing minor excisions. However, in long-term follow-up, recurrence rates were not different. Our findings may aid surgeons in expectation setting prior to excisional procedures.
  31, p. 535-544 2024
• Current Geriatric Rep
  Cooper AC, Gerjevic KA Botox Use in the Older Woman: An Advanced Bladder Treatment Option Purpose of Review This article focuses on challenges of caring for older women with urgency urinary incontinence (UUI), and asks how treatment algorithms for UUI could be tailored to the needs of older women. Recent Findings Urgency urinary incontinence is highly prevalent among older women, and has significant health, social and economic impact for patients, caregivers and society. It is more difficult to treat among older women in part due to interaction with other geriatric syndromes and comorbidities. Also, the existing treatment algorithm, including anticholinergic medications as a mainstay of therapy, is less relevant to older patients due to increased risks and limitations of all therapies. Use of onabotulinumtoxinA treatment may have a more favorable risk/benefit profile compared with other therapies, and merits consideration earlier in the treatment of older women with UUI. Summary Urgency urinary incontinence is more difficult to treat among older women, and an updated treatment algorithm is needed to meet existing and increasing need. Use of first-line therapies and beta agonists should be supported among primary care providers to accelerate access to care. Subspecialty providers should give earlier consideration of bladder onabotulintumtoxinA (BOTOX©) treatment prior to or instead of oral medications, in part because of its lower systemic side effects, favorable cost profile, and versatility of dosing. Other third line therapies remain applicable as well but have more fixed disadvantages among older patients. Research is needed to scrutinize the outcomes, side effects, and experience of BTX treatment among older women, and more broadly, to query the influence of factors such as frailty, comorbidities, dementia and polypharmacy on response to treatment of UUI.
  2, p. 1-12 2023

Presentations

• Dept. of OB/Gyn Grand Rounds 2023
• Short Oral Presentation: Geographic Variation of Apical Support Procedures performed for Pelvic Organ Prolapse American Urogynecologic Society/International Urogynecologic Society Pelvic Floor Disorders Week October 12-16, 2022 Phoenix, AZ 2022
• Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates (Poster) American Urogynecologic Society/International Urogynecologic Society Pelvic Floor Disorders Week October 12-16, 2022 Phoenix, AZ 2022
• Dept. of OBGYN Grand Rounds 2022
• Variation in Obstetrics and Gynecology Obstetrics & Gynecology Grand Rounds Dartmouth-Hitchcock Medical Center 2022
• Penicillin Allergy Testing in Obstetric Patients: A Quality Improvement Project (Poster) American College of Obstetrics and Gynecology Annual Clinical and Scientific Meeting April 30-May 2, 2021 Virtual Conference Jacksonville, FL 2021
• Improving Penicillin Allergy Testing in Pregnancy: Assessing the Referral System in an Obstetrics Clinic (Poster) Institute for Healthcare Improvement National Forum December 6-9, 2020 Virtual Conference 2020
• Singleton, Term, Vertex Cesarean Delivery on a Midwife Service Compared to an Obstetrician Service (Poster) The American College of Obstetricians and Gynecologists 69th Annual Clinical & Scientific Meeting April 24-27, 2020 Virtual Conference 2020
• Video Presentation: A Minimally-Invasive Modification for Fascia Lata Mid-Urethral Sling Society of Gynecologic Surgeons 46th Annual Scientific Meeting March 29 April 1, 2020 Virtual Conference 2020
• Using Decision Aids to Help Women Decide on the Right Treatment for Pelvic Organ Prolapse (Poster) Dartmouth-Hitchcock and Dartmouth College Scientific Retreat October 22, 2019 Hanover, NH 2019
• Short Oral Presentation: Using Decision Aids to Help Women Decide on the Right Treatment for Pelvic Organ Prolapse American Urogynecologic Society/International Urogynecologic Society Pelvic Floor Disorders Week September 24-28, 2019 Nashville, TN 2019
• A Microsystems Approach to Assessing Ambulatory Colposcopy: Addressing Patient Satisfaction, Quality, & Safety (Poster) Institute for Healthcare Improvement National Forum December 9-12, 2018 Orlando, FL 2018
• Cost-effectiveness of sacral neuromodulation (SNM) vs. onabotulinumtoxinA (BoNT/A) for refractory overactive bladder in women: A Systematic Review (Poster) American College of Preventive Medicine Annual Meeting May 23-26, 2018 Chicago IL 2018
• Pelvic Organ Prolapse and Decision Aids Obstetrics & Gynecology Grand Rounds Dartmouth-Hitchcock Medical Center 2017
• Patient Information Priorities for Deciding on Treatment of Pelvic Organ Prolapse (Poster) American Urogynecologic Society Pelvic Floor Disorders Week September 28-October 1, 2016 Denver, CO 2016

Awards

• Award for Excellence in Female Pelvic Medicine and Reconstructive Surgery
  DHMC FPMRS Division
• Gibbons Award
  American Congress of Obstetrics and Gynecology District VI
• Distinguished Student Service Award
  Carver College of Medicine
• Gold Humanism Award
  Carver College of Medicine

Consulting

• Penicillin Allergy Testing In Obstetric Patients: A Quality Improvement Project
  Research Advisor
  Elizabeth Harvey, MD Resident Research Project Penicillin Allergy Testing in Obstetric Patients: A Quality Improvement Project
  Elizabeth Harvey, MD
  2019 - 2021