Readmission and Prolapse Recurrence After Abdominal and Vaginal Apical Suspensions in Older Women

Abstract

Objective Our objective was to evaluate 30-day readmission, 12-month prolapse recurrence, and complications after apical surgeries in older women. Methods A retrospective cohort study was conducted using 2002–2011 Medicare data in women ≥65 years who underwent abdominal sacrocolpopexy with synthetic mesh, or vaginal uterosacral, or sacrospinous colpopexy with 12-months follow-up. Vaginal mesh procedures were excluded. The primary outcome was 30-day inpatient readmission. Secondary outcomes were complications and prolapse recurrence, defined as either reoperation or pessary insertion. We used Pearson Chi-square, Fisher’s tests and ANOVAs to examine difference between surgical treatment groups. Odds Ratio (OR) utilizing Charlson Comorbidity Index, age, race, and procedure type were calculated to assess the differences in the outcomes probability. Results Out of 3015 women, 863 underwent abdominal sacrocolpopexy, 510 – uterosacral, and 1642 – sacrospinous ligament suspensions. The 30-day readmission was 7.4% (95% Confidence Interval (CI) 5.7–9.2%), OR= 2.4 (95% CI 1.7–3.5, p<0.01) after abdominal sacrocolpopexy, 4.5% (95% CI 2.7–6.3%), OR=1.3 (95% CI 0.8–2.1, p=0.3) after uterosacral compared to 3.5% (95% CI 2.6–4.4% p<0.01) after sacrospinous ligament suspensions. Prolapse recurrence did not differ between the groups 8.2% (95% CI 6.4–10.1%), 10.6% (95% CI 7.9–13.3%), and 9.9%, (95 CI 8.4–11.3%, p=0.3), respectively. Women had 30-day gastrointestinal complications 6.1% (95% CI 4.5–7.7%), 1.2% (95% CI 0.2–2.1%), and 1.1% (95% CI 0.6–1.6%, p<0.01); surgical site infections 5.9% (95% CI 4.3–7.5%), 3.1% (95% 1.6–4.7%) and 3.7% (95% CI 2.8–4.6%, p=0.01); genitourinary complications 10.9% (95% CI 8.8–13%), 17.7% (95% CI 14.3–21%), and 13.6% (95% CI 12–15.3%, p<0.01); and medical complications 7.4% (95% CI 5.7–9.2%), 7.8% (95% CI 5.5–10.2%), and 4.4% (95% CI 3.4–5.4%, p<0.01); (all after abdominal sacrocolpopexy, uterosacral, and sacrospinous ligament suspensions, respectively). Conclusions Vaginal apical suspensions compared to abdominal sacrocolpopexy with synthetic mesh are associated with lower rates of postoperative 30-day readmissions without increase in prolapse recurrence among older women.

Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

“…Fifteen studies including 4,120 cases (2,409 cases for SSLF, 1,439 cases for ASC, and 272 cases for LSC) fulfilled the inclusion criteria and were included in the final analysis (Fig. 1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. All publications were full-text articles.…”

“…The characteristics of the studies included are shown in Table 1. There were 5 RCTs [14,20,21,25,28] (level of evidence: 2b) [29]; 8 retrospective studies [15,16,18,19,22,24,26,27] and 2 prospective studies (level of evidence: 2b-3b) [17,23]. As for surgical procedures, 10 studies compared SSLF with ASC [15,16,18,[20][21][22][23][24][25]28] [14,17,19,26], and 1 compared ASC, LSC, and SSLF [27].…”

“…As for surgical procedures, 10 studies compared SSLF with ASC [ 15 , 16 , 18 , 20 – 25 , 28 ], 4 compared SSLF with LSC [ 14 , 17 , 19 , 26 ], and 1 compared ASC, LSC, and SSLF [ 27 ].…”

“…All studies mentioned the length of follow-up. However, 2 of the studies provided only perioperative data [ 24 , 27 ] and 4 studies provided a short follow-up, which is less than 2 years [ 14 , 16 , 22 , 25 ]. Methods for handling missing data were not adequately described in some studies [ 15 , 17 , 23 , 24 ].…”

Resumption of sexual intercourse post partum and the utilisation of contraceptive methods in China: a cross-sectional study

“… 5 6 Some studies have focused on resumption time, frequency of sexual intercourse and influence of fatigue on sexual intercourse. 7 8 At present, the guidelines for clinical postpartum contraception recommend the initiation of effective contraception 3 weeks after delivery to avoid short pregnancy intervals. 9 Decllines in unintended pregnany rates in Africa and in Western regions are attributed to implementation of family planning.…”