Abstract: PD17-02
Sources of Funding: None

Introduction

Abdominal sacrocolpopexy (ASC) is the gold standard surgical correction for apical prolapse, but there is variability in concurrent procedures. Given the paucity of data on the impact of concurrent procedures on perioperative outcomes, we assessed if hysterectomy or midurethral sling (MUS) placement incur an increased risk of 30-day complications.

Methods

We queried the American College of Surgeons National Surgical Quality Improvement Project database using current procedure terminology codes to identify women who underwent ASC between 2006 and 2013 and any concurrent procedure. Statistical analysis of outcomes was performed using chi-square test and multivariate regression.

Results

A total of 4,944 women underwent ASC, with open approach used in 1,302 (26.3%) and laparoscopy in 3,642 (73.7%). The majority were performed by gynecologists (92.3%) and surgical approach did not differ by specialty (p>0.05). Hysterectomy was performed in 2,963 cases (59.9%) and MUS was placed in 1,699 cases (34.3%). Gynecologists were more likely than urologists to perform a concurrent hysterectomy (64.0% vs 11.4%, p<0.01) and/or place MUS (34.8% vs 29.6%, p=0.04). There was no difference in overall complications or 30-day readmission based on surgeon specialty, resident involvement, or concurrent hysterectomy (p>0.05). Overall rate of reoperation was low (1.5%) and did not differ if concurrent procedure was performed (p>0.05). Relative to patients undergoing ASC without MUS, patients who had MUS placed had a higher incidence of urinary tract infection (UTI, 4.94% vs 2.31%, p<0.01) and overall complications (7.71% vs 6.07%, p=0.03), but no difference in 30-day readmissions (1.9% vs 2.6%, p=0.1). On multivariate regression analysis, MUS was associated with increased odds of UTI (OR 2.6, p<0.01) and overall complication (OR 2.09, p<0.01), and laparoscopic approach was associated with decreased odds of overall complication (OR 0.49, p<0.01; Table 1).

Conclusions

At time of ASC, MUS placement is associated with increased risk of UTI and overall complications. Resident involvement, performing hysterectomy, and surgeon specialty are not associated with differences in complications or readmission.

Funding

None