Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American college of surgeons National surgical quality improvement program
Abstract
Background Surgical approaches to the correction of pelvic organ prolapse include abdominal, vaginal, and obliterative approaches. These approaches require vastly different anatomical dissections, surgical techniques, and operative times and are often selected by the patient and surgeon to match preoperative multimorbidity and ability of the patient to tolerate the stress of surgery.Objective We sought to describe the occurrence of postoperative complications occurring after 3 different surgical approaches to treat pelvic organ prolapse: vaginal, abdominal, and obliterative.Study design We conducted a secondary database analysis of the 2006 through 2014 American College of Surgeons National Surgical Quality Improvement Program participant use data files to analyze patients undergoing procedures for pelvic organ prolapse based on Current Procedural Terminology codes. Women were categorized into 3 surgical approaches to prolapse: vaginal, abdominal, and obliterative. Concomitant hysterectomy and sling were also examined. The primary outcome was a composite of 30-day major postoperative complications.Results A total of 33,416 women were included in our final analysis: 24,928 vaginal procedures, 6834 abdominal (4461 minimally invasive) procedures, and 1654 obliterative procedures. Concomitant hysterectomies and slings were performed in 17,380 (52.0%) and 10,896 (32.6%) of prolapse procedures. The overall prevalence of composite 30-day major postoperative complications was 3.1% (n/N = 1028/33,416). There were 13 perioperative deaths (0.04%) with no difference in the surgical approaches (P = .55). There were no differences in major postoperative complications between vaginal and abdominal procedures (3.0% vs 3.0%; P = .71). Women undergoing obliterative procedures had an occurrence of major postoperative complications of 5.0% (n/N = 83/1654), P < .001.Conclusion The occurrence of major postoperative complications after prolapse surgery is rare. We did not find a significant difference in major postoperative complications between vaginal and abdominal surgeries for pelvic organ prolapse. In this well-characterized cohort of patients who self-selected surgical approach, women undergoing obliterative surgery had more postoperative complications, likely attributed to increased age and multimorbidity.
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The study population had a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.
“The current study population had both a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.”
Many studies addressing perioperative outcomes and frailty, including in gynecologic surgery, are retrospective in nature or database driven.
“Many studies--including those looking at gynecologic surgery--addressing perioperative outcomes and frailty are retrospective in nature or database driven leaving opportunity for further understanding the impact of frailty on gynecologic surgery outcomes in prospective surgical trials.7–16”
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- Authors
- Erekson, E., Murchison, R. L., Gerjevic, K. A., Meljen, V. T., & Strohbehn, K.
- Affiliations
- Dartmouth College (US)
- Corresponding author
- Erekson, Elisabeth
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 217
- Issue
- 5
- Pages
- 608.e1-608.e17
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2621047725
- Cited by
- 34
- References
- 27
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 6 · 2019: 6 · 2018: 2
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American College of Surgeons
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Ureteral procedures and complications
- Keywords
- pelvic organ prolapse, postoperative complications, vaginal surgery, abdominal surgery, sling procedures, hysterectomy, 30-day complications, surgical approach comparison, multimorbidity, perioperative mortality, minimally invasive surgery, National Surgical Quality Improvement Program, women's health surgery, age as risk factor, pelvic floor reconstruction
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Hysterectomy, Middle Aged, Postoperative Complications, Gynecologic Surgical Procedures, United States, Vagina, Prevalence, Databases, Factual, Minimally Invasive Surgical Procedures, Plastic Surgery Procedures, Young Adult, Pelvic Organ Prolapse, Quality Improvement, Operative Time
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