Complications After Uterosacral Ligament Suspension Versus Sacrospinous Ligament Fixation at Vaginal Hysterectomy: A Retrospective Cohort Study of the National Surgical Quality Improvement Program Database.

Abstract

Apical suspension, including uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF), is the standard of care at vaginal hysterectomy. Although the equivalence of anatomic and clinical outcomes after USLS and SSLF is established, comparing surgical complications specific to patients undergoing concurrent vaginal hysterectomy further informs decision making regarding operative approach. This study aims to compare complications in the first 30 days after surgery in patients undergoing USLS and SSLF at vaginal hysterectomy for pelvic organ prolapse. This retrospective, population-based cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing USLS or SSLF at vaginal hysterectomy for pelvic organ prolapse between 2012 and 2019. The primary outcome was a composite of surgical complications excluding urinary tract infection (UTI). Odds of the primary outcome, readmission, reoperation, and UTI were evaluated by multivariable logistic regression models. Of 10,210 eligible patients, 7,127 patients underwent USLS and 3,083 patients underwent SSLF. Uterosacral ligament suspension was associated with a 25% lower odds of the composite complication outcome that excluded UTI compared with SSLF (adjusted odds ratio, 0.75; 95% confidence interval, 0.63-0.90). Urinary tract infection was the most common complication and occurred more commonly in patients undergoing USLS (6.5% vs 4.9%; adjusted odds ratio, 1.29; 95% confidence interval, 1.06-1.56). There was no significant difference in Clavien-Dindo class IV complications, readmission, or reoperation between approaches. Uterosacral ligament suspension was associated with a lower odds of complications excluding UTI compared with SSLF. Urinary tract infection was more common among patients having USLS. The odds of serious complications, readmission, and reoperation were low and comparable between groups.