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Complications after minimally invasive sacrocolpopexy with and without concomitant incontinence surgery: A National
Aisling A Clancy1, Ranjeeta Mallick2,3, Rodney H Breau2,4
1Department of Obstetrics and Gynecology, Division of Urogynecology, The Ottawa Hospital, Ottawa, Ontario, Canada.
Aims:
To compare surgical complications for patients having minimally invasive sacrocolpopexy (MISCP) with concomitant incontinence procedure, to those having MISCP alone.
Methods:
Patients undergoing MISCP with and without a concomitant incontinence procedure between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. The main outcome of interest was a composite of surgical site infection, bleeding requiring blood transfusion, return to the operating room within 30 days, and surgical stay >48 h. Log-binomial regression was used to identify independent risk factors for the outcome and to generate adjusted effect measures for variables of interest.
Results:
Seven thousand ninety-seven women met the inclusion criteria, of which 2433 (34%) underwent a concomitant incontinence procedure. Patients having incontinence procedures were slightly older (59 ± 11 vs 58 ± 12, P < 0.0001) and had longer total operating time (225 IQR 170-267 vs 184 IQR 120-232 min, P < 0.0001). Pre-operative steroid use, wound class III/IV (vs I/II), and longer operative time were independent predictors of the composite outcome. After adjusting for baseline patient characteristics and co-morbidities, no association was observed between concomitant incontinence procedure and the composite outcome (adjusted RR 0.87, 95%CI 0.65-1.18) but there was an increased likelihood of urinary tract infection (adjusted RR 2.47 95%CI 1.89-3.27).
Conclusions:
Despite being associated with a longer operative time, performing an incontinence procedure at the time of MSCIP was not associated with an increased risk of clinically important surgical complications other than urinary tract infection.
Insights
Performing minimally invasive sacrocolpopexy (MISCP) with an incontinence procedure did not increase surgical complications, except for a higher risk of urinary tract infections. This finding supports combining procedures for pelvic organ prolapse and incontinence.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Pelvic organ prolapse (POP) and urinary incontinence are common conditions affecting women.
- Minimally invasive sacrocolpopexy (MISCP) is a surgical option for POP.
- Concomitant procedures for incontinence may be considered during MISCP.
Purpose of the Study:
- To compare surgical complications between patients undergoing MISCP with and without a concurrent incontinence procedure.
- To identify risk factors for adverse surgical outcomes in MISCP patients.
Main Methods:
- Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database (2006-2015).
- Inclusion of 7,097 women undergoing MISCP.
- Composite outcome included surgical site infection, blood transfusion, reoperation within 30 days, and prolonged hospital stay (>48 hours).
- Log-binomial regression analysis was employed.
Main Results:
- 34% of patients (2,433) had a concomitant incontinence procedure.
- Patients with incontinence procedures were older and had longer operative times.
- Independent predictors of complications included steroid use, wound class, and operative time.
- No increased risk of the composite outcome was found for concomitant incontinence procedures (adjusted RR 0.87).
- A significantly increased likelihood of urinary tract infection was observed (adjusted RR 2.47).
Conclusions:
- MISCP with a concurrent incontinence procedure is not associated with increased major surgical complications.
- Urinary tract infection is a notable exception, with a higher incidence when combined procedures are performed.
- These findings suggest that combining procedures is safe, with careful consideration for UTI prevention.
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