Perioperative Outcomes and Surgical Route of Colpopexy in Women with Prior Hysterectomy

Abstract

Study Objective To compare the perioperative outcomes associated with colpopexy performed in women with prior hysterectomy via different surgical approaches. Design This is a retrospective cohort study. The National Surgical Quality Improvement Project (NSQIP) database from 2014 to 2017 was queried for all women who underwent abdominal, laparoscopic/robotic or vaginal colpopexy. Our primary outcome was the composite morbidity (including surgical site infection, pulmonary, sepsis, thromboembolic, cardiac and renal complications). Our secondary outcomes included length of stay, readmission, reoperation and surgical complications. A multivariable logistic regression adjusting for Age, BMI, operative time and surgical approach was performed. Setting Hospitals participating in the NSQIP program. Patients or Participants Women with prior hysterectomy who underwent colpopexy via different routes. Interventions N/A Measurements and Main Results 2904 colpopexies were analyzed including 328 (11.3%) abdominal, 1576 (54.3%) laparoscopic and 1000 (34.4%) vaginal colpopexies. The abdominal approach was associated with an increased risk of the primary outcome compared to the laparoscopic and vaginal approaches (6%, 2%, 1.1%, aOR: ref, 0.32(0.18-0.57), 0.24(0.1-0.52) respectively, p 2 days and readmission compared to the other approaches (all p Interestingly, vaginal colpopexy was associated with a higher risk of urinary tract infection compared to the abdominal and the laparoscopic approach (5.2%, 2.7% and 3% respectively, p Conclusion Laparoscopic and vaginal colpopexy performed in women with prior hysterectomy are associated with a lower rate of perioperative morbidity compared to the abdominal approach. The minimally invasive routes should be performed when feasible.