Perioperative adverse events in women undergoing vaginal prolapse repair with uterine preservation versus concurrent hysterectomy: a matched cohort study
Abstract
Objective: The objective of this study is to compare the incidence of perioperative adverse events (AEs) in women undergoing vaginal prolapse repair with uterine preservation (hysteropexy) versus concurrent hysterectomy. Methods: This was a retrospective matched cohort study between 2012 and 2019. Patients who received a sacrospinous or uterosacral hysteropexy or colpopexy with hysterectomy were matched by surgeon, surgical year, and age. The electronic medical record was queried for demographic and perioperative data. Strict definitions were used for all clinically relevant AEs. Results: One hundred and thirty hysteropexy (89 sacrospinous, 41 uterosacral) patients were matched to 260 concurrent hysterectomy (6 sacrospinous, 253 uterosacral, 1 both) patients. Mean age and body mass index were 58 years (±13 years) and 27.9 kg/m 2 (±6 kg/m 2 ). Compared with hysteropexy, cases with hysterectomy were longer, had higher blood loss, and a longer hospital stay. The overall incidence of AEs was 29.0% for concurrent hysterectomy versus 10.5% in hysteropexy cases ( P = 0.02); on logistic regression, concurrent hysterectomy remained a statistically significant predictor of AEs, with an adjusted odds ratio of 4.03 (95% confidence interval, 1.48–11.01). There was no difference in Dindo grade 3 complications between concurrent hysterectomy and hysteropexy procedures (0.8% vs 1.3%, P = 0.12). In a subanalysis examining the 2 hysteropexy types, there were no significant differences in AEs. Conclusions: The overall incidence of serious AEs is low in women with uterovaginal prolapse undergoing vaginal native tissue repair with or without hysterectomy. Vaginal hysteropexy is associated with lower odds of experiencing AEs, shorter operating times, a shorter length of stay, and less blood loss.
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Existing studies suggest that uterine-preserving surgery has similar or lower procedural complication rates than hysterectomy for POP treatment, but many do not distinguish native tissue from mesh repairs, do not control for perioperative risk factors, or overrely on P value interpretation.
“Additionally, existing studies suggest that UP surgery has similar or lower procedural complication rates than hysterectomy for POP treatment 11,54,55 ; however, many do not distinguish native tissue from mesh repairs, do not control for perioperative risk factors (eg, comorbidities), or overrely on P value interpretation.56”
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- Authors
- Yuan, A. S., Chang, O. H., & Ferrando, C. A.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Yuan, Angela S.
- Venue
- Female Pelvic Medicine & Reconstructive Surgery
- Published
- 2021-01-19
- Volume
- 27
- Issue
- 10
- Pages
- 621-626
- ISSN
- 2151-8378 (ISSN-L)
- 2154-4212
- OpenAlex
- W3125526950
- Cited by
- 13
- References
- 14
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 4
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Urogynecology (publishedVersion)
- PubMed (publishedVersion)
- 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
- uterine preservation, hysteropexy, vaginal hysterectomy, uterovaginal prolapse, pelvic organ prolapse surgery, perioperative complications, sacrospinous hysteropexy, colpopexy, intraoperative blood loss, length of hospital stay, operative time
- MeSH terms
- Female, Humans, Hysterectomy, Hysterectomy, Vaginal, Retrospective Studies, Gynecologic Surgical Procedures, Uterine Prolapse, Cohort Studies, Treatment Outcome
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