61 Peri-operative complications after hysterectomy for pelvic organ prolapse at a safety net teaching hospital: An observational cohort study

Abstract

Complication rates based on coding data may be under-represented at safety net hospitals because of the nature of their payor mix. Our goal was to describe the surgical complications associated with hysterectomy for pelvic organ prolapse at a safety net hospital. A secondary objective was to identify modifiable risk factors for surgical complications. This is a retrospective cohort study of women who underwent hysterectomy for pelvic organ prolapse between July 2007 and July 2019 at a large, teaching, safety net hospital. All surgical hysterectomy cases were reviewed and were included if performed for pelvic organ prolapse. Cases were excluded if the indication for hysterectomy included malignancy or atypical hyperplasia. Medical records were reviewed for demographic data, operative details, and 6-month post-operative course. All complications were classified using the Dindo system. Univariate and multivariate analyses were performed. This study was IRB approved. 759 cases were identified. 156 (20.6%) had a complication of any kind. In four cases, the complication was not related to the surgery and did not have a Dindo classification. Of the complications, 30.9% were class I, 50.7% were class IIa, 11.2% were class IIb, 3.9% were class IIIa, 3.3% were class IIIb, and no complications were classified as class IV or V. Both of the class IIIb complications were sepsis due to a cuff abscess. Intra-operative complications accounted for 20.5% of complications, but some patients had both an intra-operative and a postoperative complication. Complication rates based on procedure type were: 19.1% for vaginal, 28% for laparoscopic/robotic and 17.4 % for open hysterectomy (P=0.22). Bladder injury was the most common intra-operative complication (9.6% of all complications), while ureteral injuries (0.6%) and bowel injuries (1.9%) were less common. The most common type of post-operative complications were urinary tract infections (UTIs) (21.2% of complications) and abdominal wound complications (7.1%). Unscheduled emergency room or triage clinic visits were common (22.4% of patients with a complication). Univariate analysis revealed that estimated blood loss (EBL) was the only demographic or procedural finding that was associated with risk of complication. This finding persisted on multivariate analysis. Approximately 20% of hysterectomies for prolapse at a safety net hospital had a peri-operative complication. High blood loss was associated with peri-operative complications. Most complications were not serious, but most of the serious complications were related to infection.