Research Findings Offer Insight on Complications Following Vaginal Colpopexy on Repair of Pelvic Organ Prolapse
Study is the first of its kind to compare an intraperitoneal versus an extraperitoneal approach to prolapse surgery on a large scale.
In an effort to better inform and counsel patients, Cleveland Clinic examined differences in complication rates between intraperitoneal and extraperitoneal vaginal colpopexy, using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.
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“Vaginal surgery for repair of pelvic organ prolapse is one of the most common procedures for urogynecology,” explains lead investigator C. Emi Bretschneider, MD, Fellow in Female Pelvic Medicine and Reconstructive Surgery in the Ob/Gyn & Women’s Health Institute. “Our objective was to compare an intraperitoneal versus an extraperitoneal approach to prolapse surgery on a large scale.”
Dr. Bretschneider and her team concluded that the overall rate of complications following vaginal colpopexy for surgical correction of pelvic organ prolapse is low. While intraperitoneal colpopexy without hysterectomy was the least common type of colpopexy performed, the odds of experiencing a complication following this procedure were approximately two folds greater than following intraperitoneal colpopexy with a concurrent hysterectomy.
“We think this is an important area of research. While other studies have looked at complication rates following these kinds of surgeries, they haven’t done so on this large of a scale,” notes Dr. Bretschneider. “Our goal always is to increase our understanding, so we can better counsel patients regarding their likelihood of experiencing a given complication.”
The researchers identified patients who underwent vaginal colpopexy with or without concurrent hysterectomy between 2014 and 2016 using Current Procedural Terminology codes. They obtained patient demographics, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification system scores and total operating time. NSQIP-tracked 30-day complication codes were used to determine the complication rate as well as the rates of reoperation and readmission. Differences between groups were calculated using Student’s t-test, χ2 test, Fisher’s exact test, and Kruskal-Wallis test as appropriate. Investigators performed logistic regression to assess whether outcomes differed by type of surgery while controlling for unbalanced baseline variables.
A total of 10,271 colpopexies were performed during the study period. The mean age was 44±13 years, and the mean body mass index (BMI) was 29 ± 6. Most patients were white (78 percent) with an ASA class of 2 (66 percent). For women who underwent a hysterectomy (N = 7,497) as part of their prolapse repair, more women underwent intraperitoneal colpopexy (51 percent) than extraperitoneal colpopexy (49 percent). For women who did not undergo a concurrent hysterectomy (N = 2,774), extraperitoneal colpopexy (74 percent) was nearly three times more common that intraperitoneal colpopexy (26 percent). Factors which differed significantly across types of procedure were age, race, ASA class, the presence of a major medical comorbidity, operating time, preoperative creatinine and length of hospital stay (P < .05).
The overall rate of postoperative complications was 2.1 percent (213/10,271, 95% CI 1.8, 2.4), while the rate of readmission associated with NSQIP-tracked complication codes was 2.6 percent (267/10,271, 95% CI 0.4, 0.7) and rate of reoperation was 1.6 percent (166/10,271, 95% CI 1.4, 1.9). Patient ASA class, preoperative hematocrit, preoperative sodium and total length of stay were significantly associated with presence of a complication (P < .05). There was no significant difference in complications across the different types of surgery.
After logistic regression, intraperitoneal colpopexy without concurrent hysterectomy (aOR 1.80, 95% CI 1.03, 3.01), ASA class 3 (aOR 2.55, 95% CI 1.36, 5.19) and ASA class 4 (aOR 8.57, 95% CI 2.46, 26.43) were significantly associated with a higher incidence of complications. Increasing preoperative hematocrit (aOR 0.86, 95% CI 0.84, 0.99) was associated with a lower incidence of postoperative complications.
Other authors of the study included David Sheyn, MD, Case Western Reserve University School of Medicine; Sangeeta Mahajan, MD, Case Western Reserve University School of Medicine; Katie Propst, MD, Cleveland Clinic; and Beri M. Ridgeway, MD, Cleveland Clinic.