19 Perioperative outcomes of laparoscopic sacrocolpopexy with or without hysterectomy: A secondary analysis of the national surgical quality improvement program (NSQIP) database

Abstract

Our objective was to compare 30-day postoperative complications in women undergoing minimally invasive sacrocolpopexy (MIS SCP) with and without a concomitant hysterectomy. Using the American College of Surgeons NSQIP database, we identified women undergoing MIS SCP between 2014 and 2018 using CPT codes. Women were then stratified into 2 groups: SCP only and SCP + Hyst. The primary outcome was the occurrence of any 30-day postoperative complication. Group comparisons were performed using Student’s t-test, Mann Whitney U test, and Chi-square test. Multivariable logistic regression was used to identify factors associated with the occurrence of any complication. A total of 8,553 women underwent MIS SCP, of which 5,123 (60%) had SCP + Hyst. When compared to the SCP only group, women in the SCP + Hyst group were younger (P < 0.001) and had fewer major medical comorbidities (P < 0.001) (Table1). Median operative time was longer in women who had SCP + Hyst compared to SCP alone (185 [129-241] versus 172 [130-224] minutes, P < 0.001). The rate of any 30-day postoperative complication was 5.9% and did not differ between groups (SCP 5.8% and SCP + Hyst 5.5%, P = 0.34). Likewise, organ space, deep, and superficial SSI did not differ between groups. The most common complication was urinary tract infection (3.4%). There was no difference in reoperation rates (SCP:1.7% vs SCP + Hyst: 1.4%, P = 0.35) or readmission rates (SCP: 2.9% vs SCP + Hyst 2.4%, P = 0.19) between groups. On multivariable logistic regression controlling for the covariates listed in Table 2, SCP + Hyst was not associated with increased odds of 30-day postoperative complications relative to women who underwent SCP alone. Similarly, type of laparoscopic hysterectomy (supracervical or total) did not impact the odds of postoperative complications. As urinary tract infection (UTI) was the most common complication, we performed a secondary analysis examining non-UTI complications. Similarly, on multivariable logistic regression, hysterectomy did not increase the odds of non-UTI complications. Complications rates in the first 30-day after minimally invasive SCP are low and concomitant hysterectomy does not seem to increase risk of early complications including SSI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)