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Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience

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Abstract

Introduction and hypothesis

The surgical treatment of pelvic organ prolapse (POP) is associated with specific complications. Our primary objective was to assess the recurrence requiring reoperation after prolapse surgery, and our secondary objectives were to assess the early complications and secondary surgery for urinary incontinence.

Methods

Retrospective study of a population-based cohort of all hospital or outpatient stays including POP surgery from 2008 to 2014, using the French nationwide discharge summary database. We calculated the rates of hospital readmission following surgery as well as the rates of reoperation for recurrent prolapse and subsequent procedures performed for urinary incontinence.

Results

A total of 310,938 patients had undergone surgery for POP. Two hundred fourteen (0.07%) patients died, and 0.45% were admitted to an intensive care unit; 4.4% of the patients underwent surgery for the recurrence of prolapse. Concomitant hysterectomy in the first surgery was associated with a significantly lower risk of POP surgery recurrence: (hazard ratio (HR) [95% confidence interval (CI)] = 0.51 [0.49; 0.53]). A total of 1386 (2.5%) patients were readmitted to the hospital for early (30-day) complications of prolapse surgery. The most frequent reasons for early readmission were local infection (32.8%), hemorrhage (21.4%) and pain (17.2%). Risk factors for complications were obesity, hospitals with low levels of activity and associated incontinence surgery; 4.6% of the patients required secondary surgery for urinary incontinence; obesity was a risk factor (HR [95% CI] = 1.12 [1.01; 1.24]), and the vaginal route was a protective factor (odds ratio = 1.86 for laparoscopy, 1.44 for laparotomy and 1.25 for multiple approaches).

Conclusions

POP surgery is associated with low rates of complication and recurrence. Complications occurred most commonly following combined surgeries for both prolapse and incontinence and in hospitals with low surgical volumes. Concomitant hysterectomy appears to be protective for the need for additional prolapse surgery, and the vaginal route leads to a lower frequency of secondary surgery for urinary incontinence.

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Abbreviations

aHR:

Adjusted hazard ratio

CCAM:

Classification Commune Des Actes Médicaux

CI:

Confidence interval

HR:

Hazard ratio

ICD-10:

International Classification of Diseases, 10th edition

POP:

Pelvic organ prolapse

SD:

Standard deviation

SUI:

Stress urinary incontinence

UI:

Urinary incontinence

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Acknowledgments

This work was part of the PROBIOMESH project, funded by the INTERREG France-Wallonie-Vlaanderen program with support from the European Regional Development Fund.

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Authors and Affiliations

  1. University of Lille, CHU Lille, Pôle Femme Mère Nouveau-né, Avenue Eugène Avinée, 59000, Lille, France

    Sybil Mairesse, Géraldine Giraudet & Michel Cosson

  2. Jeanne de Flandre hospital, University of Lille II, Faculté de Médecine, Avenue Eugène Avinée, 59000, Lille cedex, France

    Sybil Mairesse

  3. CERIM, EA2694 Univ Lille, public health department CHU Lille, 59000, Lille, France

    Emmanuel Chazard & Stéphanie Bartolo

  4. Laboratoire de Mécanique de Lille-UMR CNRS 8107, 59000, Lille, France

    Michel Cosson

  5. Douai hospital, route de Cambrai, Route de Cambrai-BP 10740, 59507, Douai Cedex, France

    Stéphanie Bartolo

Authors
  1. Sybil Mairesse
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  2. Emmanuel Chazard
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  3. Géraldine Giraudet
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  4. Michel Cosson
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  5. Stéphanie Bartolo
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Contributions

S Mairesse: Manuscript writing.

S Bartolo: Protocol development, Manuscript editing.

G Giraudet: Manuscript editing.

M Cosson: Protocol development, Manuscript editing.

E Chazard: Protocol development, Data management, Data analysis.

Corresponding author

Correspondence to Sybil Mairesse.

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Mairesse, S., Chazard, E., Giraudet, G. et al. Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience. Int Urogynecol J 31, 1755–1761 (2020). https://doi.org/10.1007/s00192-019-04210-6

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  • DOI: https://doi.org/10.1007/s00192-019-04210-6

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