78: Effect of time of year on surgical outcomes in patients undergoing minimally invasive sacral colpopexy or uterosacral ligament suspension

Abstract

We sought to evaluate if the month of the year relative to fellow/resident promotions in July effects operating room (OR) time, complication rates, and prolapse recurrence for women undergoing minimally invasive sacral colpopexy (MISC) or uterosacral ligament suspension (USLS). This was a retrospective study evaluating all MISC and USLS performed at a large academic institution between Jan 2009 and Aug 2015. Patient demographics, clinical, and surgical data were compared between months with July defined as month 1 and June defined as month 12, mirroring the academic calendar year. Linear regression assessed OR time (skin incision to closure) by month adjusting for confounders. Similarly, logistic regression assessed prolapse recurrence (a composite of any POP-Q point beyond the hymen, use of pessary, or reoperation) and complications (a composite of transfusion, infection, readmission/return to OR, small bowel obstruction/ileus, mesh complication, conversion to laparotomy, or bowel/bladder/ureteral injury). A total of 1007 subjects were included from 7 surgeons. Mean age was 59.9±9.4, BMI was 27.6±4.2, with gravity 3.0±1.5 and parity 2.6±1.1. The majority had POP-Q stage III (67.7%) or stage II prolapse (25.6%). MISC represented 81.0% of surgeries (58.8% laparoscopic, 41.2% robotic-assisted). Most USLS were performed vaginally (68.1%) vs. laparoscopic/robotic. Median follow-up was 34 weeks (IQR=11–82). Mean OR time was 199.8±66.4 minutes with no impact from month in year after adjusting for confounders (β=-0.6 min, p=0.26). MISC (vs. USLS, β=36.4 min), conversion to laparotomy (β=112.9 min), and concomitant hysterectomy (β=33.4 min) all increased OR time (all p<0.001 on multivariable linear regression). Composite complications ranged from 7.9% (January) to 23.8% (March) with average 17.1%. The most common complications were readmission/return to OR (4.5%) and infections (4.4%, excluding UTI). Complications were unaffected by month (OR=0.99, 95% CI=0.95-1.04) on multivariable logistic regression where USLS was more likely to have complications than MISC (OR=1.55, 95% CI=1.05-2.28). Notably, 3 of the 4 highest complication months occurred in the 2nd half of the year (Mar, May, and Jun) and 3 of the 5 lowest complication months occurred in the 1st half of the year (Sept, Nov, and Dec). Prolapse recurrence was identified in 9.4%. Month was not a significant predictor of recurrence on multivariable logistic regression (OR=0.95, 95% CI=0.88-1.02) where MISC had less recurrence than USLS (OR=0.33, 95% CI=0.18–0.60, p<0.001). Month of year relative to resident/fellow promotion did not impact OR time, complications, or prolapse recurrence, debunking the myth of worse surgical outcomes earlier in the academic year.