52: Major adverse cardiovascular and cerebrovascular events associated with female pelvic reconstructive surgery

Abstract

To evaluate national trends in major adverse cardiovascular and cerebrovascular events (MACCE) in women undergoing pelvic reconstructive surgery (PRS). Data from the Healthcare Cost and Utilization Project National Inpatient Sample was used to identify women undergoing PRS between 2012 to 2016. Patient- and hospital-level demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and those without MACCE. MACCE was defined as all-cause mortality (ACM), cardiac arrest (CA), acute myocardial infarction (AMI) and acute ischemic stroke (AIS). Descriptive statistics are expressed as medians and interquartile ranges (IQR). Pairwise analysis was performed between groups using Wilcoxon rank-sum or Fisher’s exact test as appropriate. Multivariable logistic regression was used to identify independent risk factors for MACCE. During the study period 53,540 patients underwent PRS. The rate of MACCE was 4.8 per 1,000 surgeries. The most common form of MACCE was AMI (3.7 per 1,000), followed by AIS (0.6 per 1,000), CA (0.4 per 1,000), and ACM (0.3 per 1,000). Patients experiencing MACCE were older (median 69 years, IQR: 58-76 vs 58, 46-68, p<0.001), more likely to have a household income in the 1st quartile (28.5% vs 22.9%, p=0.03), and more likely to have Medicare as their primary insurer (60.9% vs 33.6%, p<0.001). Patients experiencing MACCE were a more likely to have major pre-existing cardiovascular comorbidities, coagulopathy, neurologic disease (ND), and diabetes (Table 1). Additionally, patients experiencing MACCE were more likely to undergo robotic colpopexy (20.7% vs 9.6%, p<0.001), vaginal colpopexy (32.0% vs 28.5%, p=0.04), bilateral salpingo-oophorectomy (25.8% vs 19.6%, p=0.03) and to receive a blood transfusion (8.2% vs 2.5%, p<0.001); and less likely to undergo hysterectomy (39.5% vs 48.8%, p=0.01) and bilateral salpingectomy (3.5% vs 6.8%, p=0.03). On logistic regression, pre-existing coagulopathy was the strongest predictor of MACCE, (aOR=5.53, 95% CI: 2.39-12.78), followed by blood transfusion (aOR=4.84, 95% CI: 1.89-12.45), congestive heart failure (CHF) (aOR=3.61, 95% CI: 1.56-8.37), ND (aOR=3.14, 95% CI: 1.23-8.06), and electrolyte abnormalities (aOR=1.99, 95% CI: 1.05-3.99). MACCE after PRS is a rare event with AMI being the most common manifestation. Pre-existing ND, CHF, coagulopathy, electrolyte disturbances, and perioperative transfusions are strongly associated with MACCE.