Surgical Management of Pelvic Floor Disorders and the Utility of Preoperative Labs

Current national guidelines advise against routine preoperative laboratory testing to assess risk of perioperative events prior to surgery for pelvic floor disorders (PFDs), yet many women undergo unnecessary testing. The primary objective was to determine the clinical utility of preoperative laboratory assessment prior to surgical management of PFDs. Secondary objectives include rates of case cancellation or postponement owing to laboratory abnormalities and factors associated with testing.

A retrospective study was performed of all surgeries within the Division of Urogynecology and Reconstructive Pelvic Surgery at a single academic medical center between 1 January 2021 and 31 December 2024. Patient demographics, clinical characteristics, and preoperative laboratory assessments were abstracted from the medical record. Case cancellation or postponement was documented. Group comparisons were performed using Student's t test and Chi-squared and Fisher's exact test for continuous and categorical variables.

During the study period, 634 surgeries were performed for PFDs. Four hundred sixty-nine (74%) women had preoperative labs performed. Laboratory abnormalities were rare and did not result in any changes to surgical management. Patients with diabetes mellitus were more likely to have preoperative labs (p = 0.02); otherwise, medical co-morbidities were similar in the two cohorts. Patients who had preoperative labs were more likely to have a hysterectomy (p < 0.001), sacrocolpopexy (p = 0.004), uterosacral ligament suspension (p = 0.001), anterior repair (p < 0.001), and posterior repair (p < 0.001).

Despite the majority of patients undergoing preoperative laboratory testing, clinically meaningful abnormalities were rare and did not change surgical management. Policies surrounding preoperative testing should be re-evaluated to reflect current national guidelines.