Risk factors for severe morbidity and mortality: a French, nationwide study of 375,075 pelvic organ prolapse...

Pelvic organ prolapse (POP) affects a woman's quality of life. Although the surgical treatment of POP is becoming increasingly common, data on early post-operative mortality are scarce. The objectives of the present study were to evaluate early mortality and major morbidity after POP surgery and to identify associated risk factors.

Using the French national discharge summary database, we retrospectively analysed all hospital stays that included POP surgery in public- or private-sector healthcare facilities between January 1st, 2015, and September 1st, 2024.

A total of 375,705 surgical procedures were included. The 30-day postoperative mortality rate was 0.08 % (n = 295), with patient age as the only risk factor. The mortality rate during the hospital stay for POP surgery was 0.05 % (n = 197); the risk factors were patient age, heart failure, and respiratory insufficiency. In a multivariate analysis, the risk of death was higher for laparotomy, transanal and multiple approaches than for vaginal surgery. The composite outcome rate (death or admission to an intensive care unit during the hospital stay for POP surgery) was 0.57 % (n = 2,124). The patient-related and surgery-related risk factors were age, heart failure, respiratory insufficiency, diabetes, obesity, and laparoscopic, laparotomy, transanal and multiple approaches.

Although the mortality rate following POP procedures was low, clinicians should provide patients with accurate, in-depth counselling before surgery. For older patients and patients with comorbidities, vaginal surgery should be preferred to laparoscopy.