74: Mode of anesthesia and perioperative outcomes associated with vaginal reconstructive surgery

Abstract

Nearly 20% of women in the United States will undergo a procedure for urinary incontinence or pelvic organ prolapse in their lifetime. Traditionally performed under general anesthesia (GA), these procedures can also be performed with other types of anesthesia. There is no population-based data evaluating the association between anesthesia type and perioperative outcomes following vaginal reconstructive procedures. Utilizing a national database, the primary outcome of this study is to compare the perioperative complication rate in women undergoing vaginal reconstructive surgery with GA, monitored anesthesia care (MAC), or regional anesthesia. Secondary outcomes include length of hospital stay, 30-day readmission, renal failure, urinary tract infections, and reoperation rates. The National Surgical Quality Improvement Program database was used to study non-pregnant women, 18 and older, undergoing vaginal surgery for urinary incontinence and/or pelvic organ prolapse from 2006 to 2015 via CPT codes. Concomitant abdominal or laparoscopic procedures and those women with known bleeding disorders were excluded. Perioperative complication within 30 days of surgery was defined as the occurrence of any of the following: death, surgical site infection, pneumonia, venous thromboembolism, intensive care unit admission, stroke, transfusion, sepsis or myocardial infarction. Modified Poisson regression was used to estimate the adjusted relative risks associated with anesthesia type for each outcome. Models were adjusted for age, race, BMI and smoking status. A total of 38,575 women who met inclusion/exclusion criteria underwent vaginal reconstructive surgery between 2006 and 2015. A total of 88.4% (n = 34,105) of these subjects underwent GA, 4.9% (n = 1885) underwent MAC, and 6.7% (n = 2585) underwent regional anesthesia. The median age was 58 years (range = 18-89). Among the patient cohort, 1.3% were underweight (BMI <18.5), 25.6% were of normal weight (BMI = 18.5-24.9), 34.4% were overweight (BMI = 25-29.9), and 38.7% were obese (BMI ≥30). The majority of subjects in the study were white (72.2%) followed by African Americans (2.9%). Hispanic ethnicity was reported in 10.1% of the cohort. Smokers made up 12% of the cohort. Concomitant hysterectomy was performed in only 0.2%. Perioperative complications were rare, occurring in a total of 636 women (1.6%). The majority of these were women who underwent GA (n = 564, MAC n = 15, regional n = 57). The adjusted risk of perioperative complications was lower in those who underwent MAC (aRR: 0.5, 95% CI: 0.3, 0.8) compared to those who underwent GA. A marginal increase in the risk of perioperative complications in the regional anesthesia group relative to the GA group was observed, but was not clinically significant (aRR: 1.3, 95% CI: 1.0, 1.7). Similarly, readmission (available from 2012 onward) was less likely in patients who underwent MAC (aRR 0.6, 95% CI: 0.4, 1.0). Perioperative complications in vaginal reconstructive surgery are uncommon and MAC anesthesia is associated with the least perioperative complications of all groups studied. These findings may help formulate a consensus on optimal anesthesia mode for inpatient and outpatient vaginal procedures.