Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse

Abstract

SummaryAccounting for selection bias, MMC is associated with decreased operative time, non-UTI morbidity, and hospital costs to patients compared with sacrocolpopexy in treating posthysterectomy prolapse. AbstractObjectives-To determine the rate of perioperative complications and cost associated with Methods-We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery (MMC, ASC, or RSC) between January 1, 2000, and June 30, 2012, at our institution. For all patients identified, perioperative complications, length of hospital stay, and inpatient costs to patients were abstracted from the medical records and compared by procedure. Inverse-probability-of-procedure weighting using propensity scores was used to obtain less-biased comparisons of outcomes between procedures.Results-A total of 512 patients met the inclusion criteria (174 MMC, 237 ASC, and 101 RSC). Using inverse-probability weighting, the MMC group had a significantly lower intraoperative complication rate (3.3% vs 11.6% for ASC; 3.4% vs 24.1% for RSC), median operative time (94 min vs 217 min for ASC; 100 min vs 228 min for RSC), and median cost ($8,776 vs $12,695 for ASC and $8,773 vs $13,107 for RSC) than the ASC and RSC groups (all P<.01). In addition, the MMC group had significantly fewer postoperative grade III+ complications than the RSC group (1.1% vs 9.4%; P<.01).Conclusions-In the treatment of posthysterectomy vaginal vault prolapse, MMC is associated with decreased non-urinary tract infection, less perioperative morbidity, and lower cost to patients compared with sacrocolpopexy.

Robotic versus Vaginal Surgery for Treatment of Pelvic Organ Prolapse: A Comprehensive Review

“…No articles were added by searching the reference lists. Therefore, 10 studies met the inclusion criteria and were added to the review [17,[25][26][27][28][29][30][31][32][33]. All included studies were prospective and retrospective studies published from 2013 to 2021 and described a total of 1424 patients.…”

“…Our table includes authors, year of publi-cation, research design, study sample, type of intervention, population age, patient characteristics, degree of prolapse, and hospital variables (Table 1, Ref. [17,[25][26][27][28][29][30][31][32][33]).…”

“…Overall, the literature considered women with many different baseline characteristics, thus preventing a quantitative synthesis of results. In particular, most papers reported statistically significant differences at baseline in the characteristics of patients undergoing robotic and vaginal surgery; in 9 papers [17,[25][26][27][29][30][31][32][33] it was unclear whether the statistical analysis accounted for these differences, thus eliminating potential bias.…”

“…We noted a variety of vaginal surgical techniques. The main vaginal surgical technique used was uterosacral ligament suspension [28][29][30][31]33], followed by Mayo-McCall culdoplasty [25][26][27] and vaginal mesh placement [17]. Almost all robotic surgeries were sacrocolpopexy.…”

“…Women in the vaginal group were significantly older in all studies, while there were no differences in body mass index (BMI) and number of vaginal deliveries between the groups. Some studies analyzed previous surgery for POP in the patients' medical history, finding them more frequent in the robotic surgery group in Anand et al [25][26][27], Jambusaria et al [17], Jaresova et al [28] while in N'Guyen et al [29] previous surgery for POP was more common in the vaginal group. In Westermann et al [32], there were no differences between the groups.…”