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A National Contemporary Analysis of Perioperative Outcomes for Vaginal Vault Prolapse

Minimally invasive Sacrocolpopexy Versus Nonmesh Vaginal Surgery

Linder, Brian J., MD, MS*†; Gershman, Boris, MD‡§; Bews, Katherine A., BS; Glasgow, Amy E., MHA; Occhino, John A., MD, MS

Female Pelvic Medicine & Reconstructive Surgery: January 9, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000678
Original Article: PDF Only
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Objective The aim of this study was to compare the perioperative morbidity of minimally invasive sacrocolpopexy (MISC) and nonmesh apical vaginal surgeries for repair of vaginal vault prolapse using data from a contemporary nationwide cohort.

Methods The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify women who underwent apical prolapse surgery via vaginal approach or MISC from 2010 to 2016. Those undergoing concomitant hysterectomy or transvaginal mesh placement were excluded. Associations of surgical approach with 30-day complications, prolonged hospitalization, and reoperation were evaluated using logistic regression. Readmission within 30 days was calculated using the person-years method and Cox proportional hazards models.

Results Overall, 6390 women underwent surgery, including 3852 (60%) via vaginal approach and 2538 (40%) via MISC. Patients undergoing MISC were younger (P < 0.0001) and less likely to have hypertension (P = 0.04) or chronic obstructive pulmonary disease (P = 0.008), with lower American Society of Anesthesiologists scores (P < 0.0001) and higher preoperative hematocrit (P = 0.009). The MISC cohort had a lower unadjusted rates of minor complications (3.9% vs 5.6%; P = 0.004), urinary tract infection (3.3% vs 4.8%; P = 0.004), and prolonged hospitalization (5.2% vs 7.9%; P < 0.0001), with a higher rate of nephrologic (P = 0.01) complications. On multivariable analysis, there were no significant associations of MISC with the risk of 30-day complications (odds ratio [OR], 1.51; 95% confidence interval [CI], 0.92–2.51; P = 0.11), prolonged hospitalization (OR, 0.96; 95% CI, 0.76–1.21; P = 0.72), readmission (HR 1.03; 95% CI, 0.71–1.49;P = 0.88), or reoperation (OR, 0.95; 95% CI, 0.57–1.60; P = 0.86).

Conclusions Minimally invasive sacrocolpopexy is associated with similar rates of 30-day complications, prolonged hospitalization, readmission, and reoperation compared with nonmesh vaginal surgeries for apical prolapse.

From the Departments of *Urology and

Obstetrics and Gynecology, Mayo Clinic, Rochester, MN;

Division of Urology, Rhode Island Hospital and The Miriam Hospital; and

§Warren Alpert Medical School of Brown University, Providence, RI; and

Surgical Outcomes Program, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.

The authors have declared they have no conflicts of interest.

Correspondence: Brian J. Linder, MD, MS, 200 First St SW, Rochester, MN 55905. E-mail: Linder.Brian@mayo.edu.

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