Postoperative appointments: which ones count?

Abstract

Although postoperative complications in women undergoing reconstructive pelvic surgery (RPS) have been characterized, little is known regarding the timeline of these occurrences. We aimed to determine the timeframe after RPS during which the majority of complications occur, to assist with planning intervals between postoperative visits. Women undergoing RPS were identified through billing information. Demographic, surgical, and complications data were extracted from electronic medical records. The Pelvic Floor Complication scale is a surgical scale tailored to women undergoing RPS. It contains three subscales: intraoperative, immediately postoperative, and delayed complications. We applied this scale to each postoperative visit (at 2, 6, and 13weeks). 396 women underwent RPS and 125 patients had 179 complications, most of which (66%) were identified by the 2-week visit. Complications at the 2-week visit consisted of urinary tract infection (UTI; 46%), wound infection (10.0%), and urinary retention (9.4%). The majority of serious complications (venous thromboembolism [VTE], ileus, small bowel obstruction [SBO], readmission, and reoperation [1 incarcerated hernia and 1 sling release]) were diagnosed by 2weeks. One patient was readmitted for ileus at between 2 and 6weeks. At between 6 and 13weeks, 1 patient was readmitted with SBO; 1 VTE was diagnosed; and 1 required reoperation for a prolapsed fallopian tube. In contrast, two thirds of the complications seen at the 13-week visit were due to granulation tissue, suture erosion or mesh erosion. The majority of non-mesh-related complications occur within the first 2weeks after RPS, whereas mesh and suture complications are more likely to be identified at the 13-week visit.