A National Contemporary Analysis of Perioperative Outcomes of Open versus Minimally Invasive Sacrocolpopexy

Brian J. Linder, John A. Occhino, Elizabeth B Habermann, Amy E. Glasgow, Katherine A. Bews, Boris Gershman

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Abstract

Purpose: We evaluated the perioperative morbidity of open abdominal sacrocolpopexy and minimally invasive sacrocolpopexy using data on a contemporary nationwide cohort. Materials and Methods: We used the ACS (American College of Surgeons) NSQIP® (National Surgical Quality Improvement Program) database to identify women who underwent abdominal or minimally invasive sacrocolpopexy from 2010 to 2016. Associations of surgical approach with 30-day complications, blood transfusion, prolonged hospitalization and reoperation were evaluated by logistic regression. Hospital readmission within 30 days was calculated by the person-years method and Cox proportional hazard models. Results: A total of 4,362 women underwent sacrocolpopexy, including abdominal sacrocolpopexy in 1,179 (27%) and minimally invasive sacrocolpopexy in 3,183 (73%). The proportion of minimally invasive sacrocolpopexy increased during the study period from 70% in 2010 to 82% in 2016. Baseline characteristics were similar between the treatment groups aside from a higher rate of chronic obstructive pulmonary disease (p = 0.03) and higher preoperative albumin (p <0.0001) among abdominal sacrocolpopexy cases. Compared to abdominal sacrocolpopexy, minimally invasive sacrocolpopexy was associated with lower rates of 30-day complications (p = 0.001), deep vein thrombosis/pulmonary embolism (p = 0.02), surgical site infections (p <0.0001), shorter hospitalization (p <0.0001) and fewer blood transfusions (p = 0.01). Minimally invasive sacrocolpopexy was also associated with a lower 30 person-days readmission rate (2% vs 2.7%, p ≤0.0001) and 30-day reoperation rate (1.1% vs 1.4%, p <0.0001). On multivariable analysis minimally invasive sacrocolpopexy was independently associated with a reduced risk of 30-day complications (OR 0.46, 95% CI 0.28, 0.76, p = 0.002), blood transfusion (OR 0.33, 95% CI 0.15, 0.74, p = 0.007), prolonged hospitalization (OR 0.16, 95% CI 0.12, 0.23, p <0.001) and readmission (HR 0.62, 95% CI 0.41, 0.96, p = 0.03). Conclusions: Minimally invasive sacrocolpopexy was associated with reduced rates of 30-day complications, blood transfusion, prolonged hospitalization and hospital readmission compared to abdominal sacrocolpopexy.

Original languageEnglish (US)
Pages (from-to)862-867
Number of pages6
JournalJournal of Urology
Volume200
Issue number4
DOIs
StatePublished - Oct 1 2018

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Blood Transfusion
Hospitalization
Patient Readmission
Reoperation
Surgical Wound Infection
Quality Improvement
Pulmonary Embolism
Proportional Hazards Models
Venous Thrombosis
Chronic Obstructive Pulmonary Disease
Albumins
Logistic Models
Databases
Morbidity
Therapeutics

Keywords

  • minimally invasive surgical procedures
  • pelvic organ prolapse
  • postoperative complications
  • robotic surgical procedures
  • urinary bladder

ASJC Scopus subject areas

  • Urology

Cite this

A National Contemporary Analysis of Perioperative Outcomes of Open versus Minimally Invasive Sacrocolpopexy. / Linder, Brian J.; Occhino, John A.; Habermann, Elizabeth B; Glasgow, Amy E.; Bews, Katherine A.; Gershman, Boris.

In: Journal of Urology, Vol. 200, No. 4, 01.10.2018, p. 862-867.

Research output: Contribution to journalArticle

Linder, Brian J. ; Occhino, John A. ; Habermann, Elizabeth B ; Glasgow, Amy E. ; Bews, Katherine A. ; Gershman, Boris. / A National Contemporary Analysis of Perioperative Outcomes of Open versus Minimally Invasive Sacrocolpopexy. In: Journal of Urology. 2018 ; Vol. 200, No. 4. pp. 862-867.
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title = "A National Contemporary Analysis of Perioperative Outcomes of Open versus Minimally Invasive Sacrocolpopexy",
abstract = "Purpose: We evaluated the perioperative morbidity of open abdominal sacrocolpopexy and minimally invasive sacrocolpopexy using data on a contemporary nationwide cohort. Materials and Methods: We used the ACS (American College of Surgeons) NSQIP{\circledR} (National Surgical Quality Improvement Program) database to identify women who underwent abdominal or minimally invasive sacrocolpopexy from 2010 to 2016. Associations of surgical approach with 30-day complications, blood transfusion, prolonged hospitalization and reoperation were evaluated by logistic regression. Hospital readmission within 30 days was calculated by the person-years method and Cox proportional hazard models. Results: A total of 4,362 women underwent sacrocolpopexy, including abdominal sacrocolpopexy in 1,179 (27{\%}) and minimally invasive sacrocolpopexy in 3,183 (73{\%}). The proportion of minimally invasive sacrocolpopexy increased during the study period from 70{\%} in 2010 to 82{\%} in 2016. Baseline characteristics were similar between the treatment groups aside from a higher rate of chronic obstructive pulmonary disease (p = 0.03) and higher preoperative albumin (p <0.0001) among abdominal sacrocolpopexy cases. Compared to abdominal sacrocolpopexy, minimally invasive sacrocolpopexy was associated with lower rates of 30-day complications (p = 0.001), deep vein thrombosis/pulmonary embolism (p = 0.02), surgical site infections (p <0.0001), shorter hospitalization (p <0.0001) and fewer blood transfusions (p = 0.01). Minimally invasive sacrocolpopexy was also associated with a lower 30 person-days readmission rate (2{\%} vs 2.7{\%}, p ≤0.0001) and 30-day reoperation rate (1.1{\%} vs 1.4{\%}, p <0.0001). On multivariable analysis minimally invasive sacrocolpopexy was independently associated with a reduced risk of 30-day complications (OR 0.46, 95{\%} CI 0.28, 0.76, p = 0.002), blood transfusion (OR 0.33, 95{\%} CI 0.15, 0.74, p = 0.007), prolonged hospitalization (OR 0.16, 95{\%} CI 0.12, 0.23, p <0.001) and readmission (HR 0.62, 95{\%} CI 0.41, 0.96, p = 0.03). Conclusions: Minimally invasive sacrocolpopexy was associated with reduced rates of 30-day complications, blood transfusion, prolonged hospitalization and hospital readmission compared to abdominal sacrocolpopexy.",
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AU - Linder, Brian J.

AU - Occhino, John A.

AU - Habermann, Elizabeth B

AU - Glasgow, Amy E.

AU - Bews, Katherine A.

AU - Gershman, Boris

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N2 - Purpose: We evaluated the perioperative morbidity of open abdominal sacrocolpopexy and minimally invasive sacrocolpopexy using data on a contemporary nationwide cohort. Materials and Methods: We used the ACS (American College of Surgeons) NSQIP® (National Surgical Quality Improvement Program) database to identify women who underwent abdominal or minimally invasive sacrocolpopexy from 2010 to 2016. Associations of surgical approach with 30-day complications, blood transfusion, prolonged hospitalization and reoperation were evaluated by logistic regression. Hospital readmission within 30 days was calculated by the person-years method and Cox proportional hazard models. Results: A total of 4,362 women underwent sacrocolpopexy, including abdominal sacrocolpopexy in 1,179 (27%) and minimally invasive sacrocolpopexy in 3,183 (73%). The proportion of minimally invasive sacrocolpopexy increased during the study period from 70% in 2010 to 82% in 2016. Baseline characteristics were similar between the treatment groups aside from a higher rate of chronic obstructive pulmonary disease (p = 0.03) and higher preoperative albumin (p <0.0001) among abdominal sacrocolpopexy cases. Compared to abdominal sacrocolpopexy, minimally invasive sacrocolpopexy was associated with lower rates of 30-day complications (p = 0.001), deep vein thrombosis/pulmonary embolism (p = 0.02), surgical site infections (p <0.0001), shorter hospitalization (p <0.0001) and fewer blood transfusions (p = 0.01). Minimally invasive sacrocolpopexy was also associated with a lower 30 person-days readmission rate (2% vs 2.7%, p ≤0.0001) and 30-day reoperation rate (1.1% vs 1.4%, p <0.0001). On multivariable analysis minimally invasive sacrocolpopexy was independently associated with a reduced risk of 30-day complications (OR 0.46, 95% CI 0.28, 0.76, p = 0.002), blood transfusion (OR 0.33, 95% CI 0.15, 0.74, p = 0.007), prolonged hospitalization (OR 0.16, 95% CI 0.12, 0.23, p <0.001) and readmission (HR 0.62, 95% CI 0.41, 0.96, p = 0.03). Conclusions: Minimally invasive sacrocolpopexy was associated with reduced rates of 30-day complications, blood transfusion, prolonged hospitalization and hospital readmission compared to abdominal sacrocolpopexy.

AB - Purpose: We evaluated the perioperative morbidity of open abdominal sacrocolpopexy and minimally invasive sacrocolpopexy using data on a contemporary nationwide cohort. Materials and Methods: We used the ACS (American College of Surgeons) NSQIP® (National Surgical Quality Improvement Program) database to identify women who underwent abdominal or minimally invasive sacrocolpopexy from 2010 to 2016. Associations of surgical approach with 30-day complications, blood transfusion, prolonged hospitalization and reoperation were evaluated by logistic regression. Hospital readmission within 30 days was calculated by the person-years method and Cox proportional hazard models. Results: A total of 4,362 women underwent sacrocolpopexy, including abdominal sacrocolpopexy in 1,179 (27%) and minimally invasive sacrocolpopexy in 3,183 (73%). The proportion of minimally invasive sacrocolpopexy increased during the study period from 70% in 2010 to 82% in 2016. Baseline characteristics were similar between the treatment groups aside from a higher rate of chronic obstructive pulmonary disease (p = 0.03) and higher preoperative albumin (p <0.0001) among abdominal sacrocolpopexy cases. Compared to abdominal sacrocolpopexy, minimally invasive sacrocolpopexy was associated with lower rates of 30-day complications (p = 0.001), deep vein thrombosis/pulmonary embolism (p = 0.02), surgical site infections (p <0.0001), shorter hospitalization (p <0.0001) and fewer blood transfusions (p = 0.01). Minimally invasive sacrocolpopexy was also associated with a lower 30 person-days readmission rate (2% vs 2.7%, p ≤0.0001) and 30-day reoperation rate (1.1% vs 1.4%, p <0.0001). On multivariable analysis minimally invasive sacrocolpopexy was independently associated with a reduced risk of 30-day complications (OR 0.46, 95% CI 0.28, 0.76, p = 0.002), blood transfusion (OR 0.33, 95% CI 0.15, 0.74, p = 0.007), prolonged hospitalization (OR 0.16, 95% CI 0.12, 0.23, p <0.001) and readmission (HR 0.62, 95% CI 0.41, 0.96, p = 0.03). Conclusions: Minimally invasive sacrocolpopexy was associated with reduced rates of 30-day complications, blood transfusion, prolonged hospitalization and hospital readmission compared to abdominal sacrocolpopexy.

KW - minimally invasive surgical procedures

KW - pelvic organ prolapse

KW - postoperative complications

KW - robotic surgical procedures

KW - urinary bladder

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