Perioperative Adverse Events Do Not Predict Recurrent Prolapse in Older Patients

Thursday, October 24, 2024

4:27 PM – 4:30 PM EDT

Location: Independence Ballroom E-H (Meeting Level 4)

Table 1. Demographic and Perioperative Variables in those with and without Recurrent Prolapse

Table 1. Demographic and Perioperative Variables in those with and without Recurrent Prolapse.docx

8-Week Postoperative Adverse Events in those with and without Recurrent Prolapse

Table 2 8-Week Postoperative Adverse Events in those with and without Recurrent Prolapse.docx

Objectives: We aimed to examine the association between perioperative adverse events (AEs) occurring within 8 weeks after prolapse surgery and recurrent prolapse at longest follow-up. We hypothesized that the occurrence of short-term perioperative adverse events would be associated with an increased risk of recurrent prolapse.

Methods: This is a secondary analysis of a dual-center retrospective cohort study of biologic females aged ≥61 years who underwent pelvic organ prolapse (POP) surgery between January 2016 and May 2023. We performed an exploratory case-control study where recurrent prolapse cases were matched 1:3 with controls by age and prolapse surgery type (apical native tissue repair, sacral colpopexy, vaginal mesh repair, or colpocleisis). Recurrent prolapse was defined as a symptomatic patient with at least stage 2 prolapse measured by Pelvic Organ Prolapse Quantification (POP-Q) or an asymptomatic patient with prolapse leading edge at or distal to the hymen at any postoperative exam. Adverse events (AEs) included intraoperative injuries and postoperative complications, such as infection, hematoma, emergency department visits, and hospital readmission. Demographic and clinical characteristics were compared using t-tests, chi-square, Fisher’s exact, and Wilcoxon rank-sum tests. Univariate and multivariable logistic regression were performed to examine associations between relevant clinicodemographic variables, perioperative AEs, and recurrent prolapse.

Results: Of 2,804 patients who underwent POP surgery, there were 333 (11.9%) cases of recurrent prolapse which were matched to 998 controls. Mean age and body mass index were 69.3±5.9 years and 27.6±4.9 kg/m2, respectively. Composite AEs were not significantly associated with recurrent prolapse (30.3% vs 25.2%, p=0.06). On univariate analysis, increased parity was associated with recurrent prolapse [2 (2-3) vs 2 (2-3), p=0.02] while current tobacco use was protective against recurrent prolapse (2.5% vs 5.5%, p=0.03). Pre-operative genital hiatus measurements were larger (4.5cm vs 4.0cm, p< 0.01), and point Ba was more distal from the hymen (+2.5cm vs +2.0cm, p=0.02) in patients who experienced recurrent prolapse. Those with recurrent prolapse had longer outpatient follow-up [404 (205-884) days vs 126 (48-385) days, p< 0.01]. Most patients with recurrent prolapse elected for observation (n=234, 70.3%). Fewer patients chose pelvic floor physical therapy (n=37, 11.1%) or pessary use (n=39, 11.7%). Only 63 (18.9%) patients underwent repeat surgical repair for recurrent prolapse management. On multivariable logistic regression analysis, composite AEs were not associated with recurrent prolapse (adjusted OR (aOR) 1.21, 95% CI 0.88-1.67) and the association between tobacco use and recurrent prolapse was no longer significant (aOR 0.50, 95% CI 0.21-1.8). Greater parity was associated with increased odds of recurrent prolapse (aOR 1.17, 95% CI 1.04-1.31).

Conclusions: Recurrent prolapse was not associated with AEs in older urogynecologic patients who underwent POP surgery. This insight informs patient counseling and expectations regarding prolapse repair durability for patients who experience complications perioperatively.

Disclosure(s):

Nicole A. Meckes, MD: No financial relationships to disclose

Stephanie W. Zuo, MD, MS: No financial relationships to disclose

Kristina J. Warner, MD: No financial relationships to disclose

Steven R. Orris, BS: No financial relationships to disclose

Tien C. Nguyen, BSA: No financial relationships to disclose

Kristiana B. McLarty, MD: No financial relationships to disclose

Brigid S. Mumford, MD: No financial relationships to disclose

Kavya Bellam, n/a: No financial relationships to disclose

Richael Rayen: No financial relationships to disclose

Mary F. Ackenbom, MD, MSc: No financial relationships to disclose

Rapid Fire Presenter(s)

Nicole A. Meckes, MD (she/her/hers)

Urogynecology and Reconstructive Pelvic Surgery Fellow Physician
UPMC Magee-Womens Hospital
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

Stephanie W. Zuo, MD, MS (she/her/hers)

Assistant Professor
University of Virginia
Charlottesville, Virginia, United States

Disclosure(s): No financial relationships to disclose
Kristina J. Warner, MD (she/her/hers)

Urogynecologist
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois, United States

Disclosure(s): No financial relationships to disclose
SO

Steven R. Orris, BS (he/him/his)

Research Coordinator
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose
Tien C. Nguyen, BSA

Medical Student
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose
Kristiana B. McLarty, MD (she/her/hers)

Resident Physician
University of Pittsburgh Medical Center (UPMC) Magee-Womens Hospital
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose
Brigid S. Mumford, MD (she/her/hers)

Fellow Physician
Beth Israel Deaconess Medical Center
Combridge, Massachusetts, United States

Disclosure(s): No financial relationships to disclose
KB

Kavya Bellam, n/a

Research Assistant
University of Pittsburgh Medical Center
Santa Clara, California, United States

Disclosure(s): No financial relationships to disclose
RR

Richael Rayen

Undergraduate Research Assistant
Magee-Womens Research Institute
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose
MA

Mary F. Ackenbom, MD, MSc (she/her/hers)

Assistant Professor
Magee-Womens Research Institute
Pittsburgh, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose