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A comparison of 30-day surgical outcomes for minimally invasive and open sacrocolpopexy
Mark D Tyson1, Christopher E Wolter
1Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona.
Aims:
Minimally invasive sacrocolpopexy (MISC) has gained widespread acceptance without randomized or population-based data to support its use. This study compares 30-day outcomes after MISC and open sacrocolpopexy (OSC) using population-based data.
Methods:
The National Surgical Quality Improvement Program (NSQIP) database was used to acquire 1,786 sacrocolpopexy operations (659 OSC and 1,127 MISC) performed from 2005 to 2011. A propensity-weighted comparative analysis of perioperative morbidity was performed.
Results:
Among women undergoing sacrocolpopexy, the proportion of MISC procedures increased from 7.1% in 2006 to 68.8% in 2011. Women undergoing OSC were older (P < 0.001) and had somewhat higher American Society of Anesthesiologists classifications (P = 0.11). Unadjusted comparisons between groups revealed higher rates of superficial (P < 0.001) and deep surgical (P = 0.009) site infections in the OSC group. There was also a higher rate of blood transfusions (P = 0.02), a longer length of hospitalization (P < 0.001), and a shorter operative time (P < 0.001) among patients undergoing OSC. In the propensity-weighted analysis, MISC was associated with lower rates of wound infections (1.1% vs. 3.0%; P = 0.01), lower blood transfusion rates (0.7% vs. 2.3%; P = 0.01), a shorter mean hospitalization (1.4 vs. 3.0 days; P < 0.001), and a longer mean operative time (224.8 vs. 188.6 min; P < 0.001). No differences were noted among renal, infectious, or neurologic complications, although pulmonary complications were higher in the OSC group (0.3% vs. 1.0%; P = 0.08). No differences in 30-day mortality were noted (0.1% vs. 0.2%; P = 0.61).
Conclusions:
MISC was associated with lower perioperative morbidity in this propensity-weighted analysis.
Insights
Minimally invasive sacrocolpopexy (MISC) shows lower infection and transfusion rates compared to open sacrocolpopexy (OSC). This population-based study found MISC associated with reduced perioperative morbidity, supporting its use.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Minimally invasive sacrocolpopexy (MISC) is increasingly adopted without robust population-based evidence.
- Open sacrocolpopexy (OSC) remains a comparator, but comparative outcome data is limited.
Purpose of the Study:
- To compare 30-day perioperative outcomes between MISC and OSC using population-based data.
- To evaluate the safety and efficacy of MISC versus OSC in a large patient cohort.
Main Methods:
- Utilized the National Surgical Quality Improvement Program (NSQIP) database (2005-2011).
- Included 1,786 sacrocolpopexy procedures (1,127 MISC, 659 OSC).
- Performed a propensity-weighted comparative analysis of perioperative morbidity.
Main Results:
- MISC procedures increased significantly from 7.1% to 68.8% between 2006 and 2011.
- Propensity-weighted analysis revealed MISC had lower wound infection rates (1.1% vs. 3.0%) and blood transfusion rates (0.7% vs. 2.3%).
- MISC was associated with shorter hospital stays (1.4 vs. 3.0 days) and longer operative times (224.8 vs. 188.6 min) compared to OSC.
Conclusions:
- Minimally invasive sacrocolpopexy is associated with reduced perioperative morbidity.
- Findings support the growing adoption of MISC for sacrocolpopexy procedures.
- MISC demonstrates favorable outcomes regarding infections and transfusions compared to OSC.
