Timing of early complications following hysterectomy for pelvic organ prolapse: national database analysis

Abstract

To analyze the time to diagnosis of early complications following hysterectomy for pelvic organ prolapse (POP) and assess factors impacting timing of diagnosis. Cases were selected from the National Surgical Quality Improvement Program (NSQIP) using procedural codes for hysterectomy and diagnostic codes for POP for the years 2015-2019. Median and interquartile range (IQR) in days to diagnosis for the 22 complications reported in the NSQIP database were assessed. Bivariate analyses, Kaplan-Meier curves, and Cox proportional hazard models were used for the 5 most common complications to assess differences in time to diagnosis based on peri-operative factors. A total of 14,748 patients were included with average age of 60.5 ± 11.8 and BMI of 28.3 ± 5.6 kg/m2. Apical prolapse was the primary diagnosis in 84.1% of cases. The most common complications with their median and IQR for time to diagnosis in days were urinary tract infection (UTI) (11 [7-18], N=775), blood transfusion (1 [0-2], N=128), superficial surgical site infection (SSI) (15 [10-21], N=110), organ space infection (13 [8-18.5], N=109), intestinal obstruction (6 [4-10], N=47), sepsis (11 [6.75-16.75, N=38), and pneumonia (8.5 [2-16], N=26). Out of infectious etiologies, earliest median day to diagnosis was noted for septic shock (8.5) and pneumonia (8.5) and latest for superficial SSI (15, p<0.001). Kaplan-Meier curves showed that time to diagnosis was earlier for UTIs in cases with concurrent sling, urogynecologist surgeon, and vaginal hysterectomy (all p<0.001). These differences persisted when controlling for peri-operative and demographic factors in the Cox regression (Table). Vaginal and laparoscopic hysterectomies compared to abdominal route had lower hazard ratios (HR) for superficial SSI and blood transfusion (Table). For intestinal obstruction, HRs were lower for laparoscopic and vaginal hysterectomies compared to abdominal route (0.36, p=0.028 and 0.24, p=0.003, respectively). Time to diagnosis varies for different complications after hysterectomy for POP which may assist in providing patients with anticipatory guidance after surgery.