Effect of BMI on clinical outcomes following minimally invasive sacrocolpopexy

Patnam, Radhika; Husk, Katherine E.; Sripad, Abhishek; Barletta, Kathryn; Dieter, Alexis A.; Geller, Elizabeth J.

doi:10.1007/s11701-020-01079-2

Cited by 4 publications

(10 citation statements)

References 20 publications

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“…However, our study was designed as a descriptive study, and as such, we did not power specifically to answer this question. Our cohort has similar prolapse recurrence rates to other minimally invasive sacrocolpopexy studies in the literature, 15–17 even at less than a year of follow-up, which is very comparable with Patnam et al 17 who found a 28% recurrence rate. We used a composite prolapse recurrence outcome, similar to Patnam et al, 17 and this may explain the recurrence rates that we observed in our patient population.…”

Section: Discussionsupporting

confidence: 89%

“…Our cohort has similar prolapse recurrence rates to other minimally invasive sacrocolpopexy studies in the literature, 15–17 even at less than a year of follow-up, which is very comparable with Patnam et al 17 who found a 28% recurrence rate. We used a composite prolapse recurrence outcome, similar to Patnam et al, 17 and this may explain the recurrence rates that we observed in our patient population. However, we recognize that the number of women in this subset is small, and further investigation of this clinical outcome is required.…”

Section: Discussionsupporting

confidence: 89%

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Anatomic Variation of Sacral Mesh Attachment During Minimally Invasive Sacrocolpopexy

Clark¹,

Dang²,

Bonnet

et al. 2022

UROGC

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Importance Although anatomic level of mesh attachment to the sacrum varied during minimally invasive sacrocolpopexy with a large proportion above S1, this was not associated with pelvic organ prolapse recurrence. Objective This study aimed to describe the anatomic level of sacral mesh attachment and its association with prolapse recurrence after minimally invasive sacrocolpopexy. Study Design This study included a retrospective cohort of women who underwent minimally invasive sacrocolpopexy with subsequent abdominal and pelvic imaging (magnetic resonance imaging or computed tomography) between 2010 and 2019 at a single academic institution. Anatomic level of attachment was determined by a radiologist. Prolapse recurrence was defined as a composite of self-reported bulge symptoms, any prolapse measure beyond the hymen, and any retreatment with pessary or surgery. χ 2 Tests were used for comparative outcomes. Results Analyses included 212 women. The mean ± SD age was 58.8 ± 9.9 years, the majority have preoperative stage III/IV prolapse (81.1%), and the median follow-up was 269 days (interquartile range, 57-825 days). Mesh was attached using titanium tacks (n = 136 [64.2%]) and suture (n = 76 [35.8%]) at the level of the L5-S1 intervertebral space (n = 113 [53.3%]) or overlying S1 (n = 89 [42.0%]).The surgical approach was significantly associated with attachment location with a greater proportion of laparoscopy cases demonstrating mesh attachment above S1 (85 [62.5%] vs robotically, 30 [39.5%]; P < 0.01). Dichotomized level of attachment was not associated with composite prolapse recurrence (above S1, n = 18 [22.2%] vs below S1, n = 24 [24.7%]; P = 0.69) or any compartment recurrence ( P ≥ 0.36). Conclusions Mesh was primarily attached to the anterior longitudinal ligament at the level of the L5-S1 intervertebral space or S1. Level of mesh attachment was not associated with composite prolapse recurrence.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Anatomic Variation of Sacral Mesh Attachment During Minimally Invasive Sacrocolpopexy

Clark¹,

Dang²,

Bonnet

et al. 2022

UROGC

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“…This study builds on previous studies comparing short-term outcomes after sacrocolpopexy and vaginal surgery between normal weight, overweight, and obese patients by assembling a cohort of overweight and obese patients that is much larger than the largest cohort represented in these single-center retrospective studies. [12][13][14][15][16]20 In addition, we expanded on the analysis of women of all BMI classes by Linder et al 11 by constructing a robust prespecified multivariable model adjusting for more preoperative comorbidities to isolate the contribution of BMI to the odds of complication by surgical approach in the setting of the known increased chronic disease burden in this population. 30 Strengths of this study include that the cohort represents a North America-wide, population-based sample comprising both tertiary and community sites derived from a validated source with an established mechanism to minimize loss to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Comparisons of apical repair surgical approaches have been completed in a population of patients across all body mass index (BMI) categories and no difference was found in short-term outcomes between approaches. 10,11 Several studies have compared outcomes following vaginal surgery 12,13 and sacrocolpopexy [14][15][16][17][18][19][20] between obese and nonobese patients noting higher complication rates in obese patients. In addition, several systematic reviews have examined complications between approaches, but these have not compared approaches in patients with elevated BMI.…”

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confidence: 99%

Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database

Stairs

Minassian

Clancy

2022

Female Pelvic Med Reconstr Surg

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Importance: Overweight and obese women represent a growing share of pelvic floor reconstruction surgeons' practices. Determining perioperative risk specific to this population is essential to inform decision making regarding operative approach in this population. Objective:The aim of the study was to compare surgical complications among overweight and obese women undergoing apical compartment prolapse surgery by either minimally invasive abdominal or vaginal approach.Study Design: The American College of Surgeons National Surgical Quality Improvement Database was used to identify overweight and obese patients (body mass index ≥ 25) undergoing either minimally invasive sacrocolpopexy (MISC) or vaginal vault suspension (VVS) in the form of a sacrospinous vault fixation or uterosacral ligament fixation for pelvic organ prolapse from 2012 to 2019. Odds ratios for surgical complications, readmission, and reoperation were estimated using multivariable logistic regression.Results: Of 8,990 eligible patients, 5,851 underwent a VVS and 3,139 patients underwent MISC. There was a greater odds of any complication in the first 30 days following VVS (n = 608 [10.4%]) compared with MISC (n = 247 [7.9%]; odds ratio, 1.27; 95% confidence interval, 1.08-1.48) on multivariable analysis. Urinary tract infections (UTIs) were the most common complication and were more likely following VVS (112 (3.6%) versus 350 (6.0%), P < 0.001). When UTIs were excluded, there was no difference in complications between approaches (1.00; 95% CI, 0.82-1.22). There were no statistically significant odds of readmission, reoperation, or serious complications between approaches. Conclusions:Vaginal vault suspension may be associated with a higher odds of any complication compared with MISC in overweight and obese women, but the rate of serious complications, readmission, and reoperation are low, and approaches were comparable when considering complications other than UTI.

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“…34,55 The mechanism underpinning how diabetes and smoking increase mesh complications is thought to be as a result of increased systemic chronic inflammation, whereas parity is thought to cause direct tissue injury to the pelvic floor. 51,[56][57][58] Reliably determining which patients are at an increased risk of developing complications following PPL mesh implantation for any use is currently not possible. 59 Most studies do not include controls and do not describe the mesh type used or its properties, making meta-analysis challenging and limiting generalizability.…”

Section: [H1] Patient-specific Risk Factorsmentioning

confidence: 99%

Host–biomaterial interactions in mesh complications after pelvic floor reconstructive surgery

et al. 2021

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Polypropylene (PPL) mesh is widely used in pelvic floor reconstructive surgery for prolapse and stress urinary incontinence. However, some women, particularly those women treated using transvaginal PPL mesh placement for prolapse, experience intractable pain and mesh exposure or extrusion. Explanted tissue from patients with complications following transvaginal implantation of mesh is typified by a dense fibrous capsule with an immune-cell rich infiltrate suggesting that the host immune response has a role in transvaginal PPL mesh complications through the separate contributions of the host (patient), the biological niche within which the material is implanted, and biomaterial properties of the mesh. This immune response might be strongly influenced by both the baseline inflammatory status of the patient, surgical technique and experience, and the unique hormonal, immune and microbial tissue niche of the vagina. Mesh porosity, surface area and stiffness also might have an effect on the immune and tissue response to transvaginal mesh placement. Thus, a regulatory pathway is needed for mesh development that recognizes the roles of host and biological factors in driving the immune response to mesh alongside mandatory mesh registries and the longitudinal surveillance of patients.

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Effect of BMI on clinical outcomes following minimally invasive sacrocolpopexy

Cited by 4 publications

References 20 publications

Anatomic Variation of Sacral Mesh Attachment During Minimally Invasive Sacrocolpopexy

Anatomic Variation of Sacral Mesh Attachment During Minimally Invasive Sacrocolpopexy

Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database

Host–biomaterial interactions in mesh complications after pelvic floor reconstructive surgery

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