Utility of Pre-operative Laboratory Testing for Patients Undergoing Colpocleisis

Objectives: Colpocleisis, a surgery to address pelvic organ prolapse via vaginal obliteration, is considered to be effective and safe with a low risk profile. However, there is limited guidance on obtaining routine pre-operative laboratory testing prior to colpocleisis. Our objective was to identify patient demographics associated with having pre-operative laboratory testing prior to undergoing colpocleisis, and to compare post-operative complication rates between those with pre-operative laboratory testing and those without pre-operative laboratory testing.

Methods: This was a secondary analysis of National Surgical Quality Improvement Program (NSQIP) database. Female patients undergoing colpocleisis (LeFort, partial vaginectomy or total vaginectomy) from 2014 to 2022 were identified using Current Procedural Terminology codes (57120, 57106, 57110, respectively). Patients who underwent concomitant hysterectomy were excluded. Data on patient demographics, concomitant surgeries (anterior repair, posterior repair with or without perineoplasty, and midurethral sling), and post-operative complication were extracted. Patients were then divided into those with pre-operative laboratory testing (complete blood count [CBC] and basic metabolic panel [BMP]) and those without pre-operative CBC and BMP. These two groups were compared using Students’ t, Mann-Whitney U, chi-squared or Fisher’s exact test, as appropriate. Multivariable logistic regression was performed to identify demographic and peri-operative factors associated with having pre-operative laboratory testing and post-operative complications associated with not having pre-operative laboratory testing.

Results: During the study period, there were 2,682 colpocleisis (73.5% LeFort, 14.7% partial vaginectomy, and 11.8% total vaginectomy). Of these, 318 (11.9%) did not have pre-operative laboratory testing. More patients who had pre-operative laboratory testing had the following characteristics (Table 1): older, identify as Black or Native Hawaiian/Other Pacific Islander, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension on medication, diabetes mellitus on medication, American Society of Anesthesiologist (ASA) Class of 3 or 4, and concomitant midurethral sling surgery. On multivariate logistic regression, the following factors remained significantly associated: age, ethnicity, chronic obstructive pulmonary disease, hypertension, ASA Class 3 or 4, and concomitant midurethral sling (Table 2). The composite post-operative complication rate 7.7% for those with and 7.5% for those without pre-operative laboratory testing.(p=0.9). There was no significant difference between the two groups in terms of any post-operative complications.

Conclusions: We found that patients who are older, of Hispanic ethnicity, have chronic obstructive pulmonary disease, hypertension requiring medication, ASA Class 3 or 4, or undergoing concurrent sling were more likely to have pre-operative laboratory testing prior to colpocleisis. However, there were no significant differences in post-operative complications whether or not pre-operative laboratory testing was performed. Our findings cautiously suggest that pre-operative laboratory testing may potentially be omitted for patients undergoing colpocleisis.