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Pelvic Pain and Apical Prolapse Surgery

A Population-Based Retrospective Cohort Study

Borahay, Mostafa A. MD, PhD*; Zeybek, Burak MD; Patel, Parin MD; Lin, Yu-Li MS§; Kuo, Yong-Fang PhD§; Kilic, Gokhan S. MD

Female Pelvic Medicine & Reconstructive Surgery: November 29, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000674
Original Article: PDF Only

Objectives The aims of this study were to evaluate the association of preoperative pelvic pain with operative characteristics and the association of patient and operative characteristics with postoperative pain.

Methods This is a retrospective cohort study utilizing Clinformatics DataMart, a large national commercial insurance database. We collected data for patients older than 18 years who underwent apical prolapse surgery between January 2005 and December 2014. We stratified data by preoperative (prior) pain and analyzed for associations of prior and postoperative pain. Logistic regression analysis was performed using SAS software.

Results A total of 14,440 patients met inclusion criteria and were analyzed. Patients with prior pain were more likely to have an abdominal (open or laparoscopic) approach, a concomitant hysterectomy, but less likely to have additional repairs or a mesh insertion (P < 0.001). Postoperative pain was less with a concomitant hysterectomy, whether they had prior pain (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.41–0.77) or not (OR, 0.68; 95% CI, 0.56–0.82). Additional vaginal repairs were associated with more postoperative pain for those without prior pain (OR, 1.63; 95% CI, 1.3–2.04). Age older than 45 years was associated with less pain. Length of hospital stay of more than 2 days was associated with more pain.

Conclusions Patients with prior pain were more likely to undergo an abdominal approach and have a concomitant hysterectomy. Postoperative pain was less with a concomitant hysterectomy, but more with additional vaginal repairs. There is a need to include pain as an outcome in future studies, particularly clinical trials.

From the *Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, MD;

Department of Obstetrics and Gynecology, Yale University, New Haven, CT; and Departments of

Obstetrics and Gynecology and

§Preventive Medicine and Community Health, the University of Texas Medical Branch, Galveston, TX.

Correspondence: Mostafa A. Borahay, MD, PhD, Department of Gynecology & Obstetrics, Johns Hopkins University, 4940 Eastern Ave, Baltimore, MD 21224. E-mail:

This work was supported, in part, by National Institutes of Health grant 1R01HD094380-01 to M.A.B.

The authors have declared they have no conflicts of interest.

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