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Mode of anesthesia and major perioperative outcomes associated with vaginal surgery

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Abstract

Introduction and hypothesis

The primary aim was to compare the incidence of major perioperative complications in women undergoing vaginal reconstructive surgery with general, regional, and monitored anesthesia care using a national database. The secondary aim was to compare length of hospital stay, 30-day readmission rates, urinary tract infections, and reoperation rates between anesthesia types.

Materials and methods

The National Surgical Quality Improvement Program database was used to study women undergoing vaginal surgery for pelvic floor disorders from 2006 to 2015 via Current Procedural Terminology codes. Demographic and clinical variables were abstracted. The incidence of major perioperative complications was defined as the occurrence of any of the following within 30 days of surgery: death, surgical-site infection, pneumonia, venous thromboembolism, intensive care unit admission, stroke, transfusion, sepsis, and myocardial infarction. Regression analysis was used to estimate the relative risks (RR) associated with anesthesia type for each outcome.

Results

From the database, we gathered data on 37,426 women who underwent vaginal reconstructive surgery between 2006 and 2015; 87.2% (n = 32,623) underwent general, 6.9% (n = 2565) regional, and 5.9% (n = 2238) monitored anesthesia care. Major perioperative complications occurred in 560 women (1.5%). Relative to general anesthesia, the adjusted risk of major perioperative complications was not significantly different in those receiving monitored or regional anesthesia [monitored vs. general, adjusted RR 0.74, 95% confidence interval (CI) 0.45–1.20; regional vs. general, adjusted RR 1.23, 95% CI 0.92–1.65].

Discussion

Major perioperative complications in vaginal reconstructive surgery were uncommon, and no differences were observed between monitored, regional, and general anesthesia outcomes.

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Author information

Authors and Affiliations

  1. The Ohio State University Wexner Medical Center, Female Pelvic Medicine and Reconstructive Surgery, 395 W 12th Ave, 5th Floor, Columbus, OH, 43210, USA

    Pamela E. Smith, Lopa K. Pandya, Andrew F. Hundley & Catherine O. Hudson

  2. Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, 200 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA

    Erinn M. Hade & Yubo Tan

Authors
  1. Pamela E. Smith
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Corresponding author

Correspondence to Pamela E. Smith.

Ethics declarations

ACS-NSQIP disclaimer

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the sources of data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Financial disclaimers

The following authors received the 2017 Clinical Research Grant from the International Urogynecological Association for unrelated work: Pamela E. Smith, MD; Catherine O. Hudson, MD.

Conflict of interest

Yubo Tan, MS, Erinn M. Hade, PhD, Lopa K. Pandya, MD, Andrew F. Hundley, MD declare no conflict of interest.

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Appendix 1

Appendix 1

Included current procedural terminology codes by category

Urinary incontinence

51,715, 57,287, 57,288

Vaginal reconstructive procedures

45,560, 56,800, 56,810, 57,110, 57,120, 57,200, 57,210, 57,220, 57,230, 57,240, 57,250, 57,260, 57,265, 57,267, 57,268, 57,282, 57,283, 57,285, 57,289, 57,295, 57,555, 57,556

Vaginal hysterectomy

58,260, 58,262, 58,263, 58,267, 58,270, 58,275, 58,280, 58,290, 58,291, 58,292, 58,294

Excluded current procedural terminology codes by category

Abdominal or laparoscopic reconstructive procedures

57,270, 57,280, 57,284, 57,423, 57,425, 58,400

Concomitant procedures outside of FPRMS practice

10,060, 10,061, 10,121, 10,140, 11,000, 11,008, 11,100, 11,101, 11,200, 11,300, 11,305, 11,306, 11,400, 11,401, 11,402, 11,403, 11,404, 11,406, 11,420, 11,421, 11,422, 11,423, 11,424, 11,426, 11,450, 11,462, 11,470, 11,602, 11,620, 11,622, 11,623, 11,770, 11,952, 11,982,12,001, 12,002, 12,020, 12,021, 12,032, 12,034, 12,041, 12,042, 13,101, 13,131, 13,160, 14,040, 14,041, 14,301, 15,002, 15,100, 15,175, 15,200, 15,275, 15,570, 15,734, 15,824, 15,830, 15,839, 15,847, 15,850, 15,851, 15,877, 15,879, 17,000, 17,110, 17,999, 19,120, 19,125, 19,301, 19,316, 19,318, 19,325, 19,340, 19,355, 19,357, 20,103, 20,245, 20,552, 20,605, 20,920, 20,922, 20,931, 20,936, 21,930, 21,932, 22,902, 25,000, 26,055, 26,115, 26,160, 27,076, 27,087, 27,240, 27,250, 27,267, 27,282, 27,295, 27,337, 28,270, 28,289, 28,300, 28,360, 28,725, 28,750, 29,873, 29,875, 29,881, 30,140, 31,255, 31,256, 31,525, 31,526, 31,541, 31,571, 36,561, 36,589, 37,700, 37,722, 37,765, 37,799, 38,510, 38,525, 38,571, 38,792, 40,819, 43,200, 43,239, 43,840, 44,005, 44,110, 44,120, 44,140, 44,155, 44,180, 44,188, 44,202, 44,205, 44,207, 44,238, 44,312, 44,314, 44,602, 44,799, 44,955, 44,970, 45,100, 45,112, 45,130, 45,300, 45,305, 45,330, 45,331, 45,338, 45,378, 45,380, 45,383, 45,400, 45,402, 45,505, 45,540, 45,541, 45,550, 45,562, 45,800, 45,805, 45,820, 45,825, 45,905, 45,915, 45,990, 45,999, 46,020, 46,083, 46,200, 46,220, 46,221, 46,230, 46,250, 46,255, 46,260, 46,270, 46,280, 46,285, 46,320, 46,505, 46,600, 46,610, 46,700, 46,735, 46,744, 46,748, 46,750, 46,760, 46,761, 46,917, 46,922, 46,945, 46,946, 46,947, 46,999, 47,562, 47,563, 47,600, 49,000, 49,082, 49,203, 49,255, 49,320, 49,321, 49,322, 49,324, 49,329, 49,402, 49,505, 49,507, 49,525, 49,550, 49,553, 49,555, 49,560, 49,565, 49,568, 49,570, 49,585, 49,587, 49,650, 49,651, 49,652, 49,654, 49,655, 49,656, 49,900, 49,999, 50,387, 50,575, 50,590, 50,605, 50,715, 50,760, 50,780, 50,810, 50,815, 50,820, 50,825, 50,947, 50,948, 51,020, 51,030, 51,040, 51,045, 51,050, 51,065, 51,550, 51,610, 51,720, 51,800, 51,840, 51,841, 51,845, 51,880, 51,900, 51,960, 51,990, 51,992, 51,999, 52,234, 52,235, 52,240, 52,250, 53,440, 57,106, 57,107, 57,109, 57,296, 57,305, 57,307, 57,426, 57,530, 57,720, 58,140, 58,150, 58,180, 58,200, 58,240, 58,541, 58,542, 58,543, 58,544, 58,546, 58,548, 58,550, 58,552, 58,553, 58,554, 58,570, 58,571, 58,572, 58,573, 58,578, 58,600, 58,611, 58,615, 58,660, 58,661, 58,662, 58,670, 58,671, 58,700, 58,720, 58,740, 58,900, 58,920, 58,925, 58,940, 58,943, 58,951, 58,999, 60,240, 62,311, 62,360, 63,685, 64,425, 64,430, 64,450, 64,488, 64,581, 64,585, 64,590, 64,595, 64,614, 64,646, 64,721, 64,774, 67,312, 69,631, 88,305

  1. FPRMS Female Pelvic Medicine and Reconstructive Surgery

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Smith, P.E., Hade, E.M., Tan, Y. et al. Mode of anesthesia and major perioperative outcomes associated with vaginal surgery. Int Urogynecol J 31, 181–189 (2020). https://doi.org/10.1007/s00192-019-03908-x

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