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Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using data from the National Surgical Quality Improvement Program Database (NSQIP)

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Abstract

Introduction and hypothesis

To define the reasons for hospital readmissions following surgery for pelvic organ prolapse by surgical approach.

Methods

Patients undergoing surgery for pelvic organ prolapse from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology and International Classification of Diseases codes. Hazard risks of readmission by surgical approach (vaginal, laparoscopic, abdominal, or combined) were determined by multivariable cox regression. Diagnoses and timing of readmission by surgical approach were examined.

Results

Of 57,233 women undergoing surgery for pelvic organ prolapse during the study period, 1073 (1.9%) were readmitted to the hospital within 30 days postoperatively. After adjusting for prespecified potential confounders, laparoscopic and abdominal surgical approaches were associated with higher risks of readmission relative to a vaginal approach (aHR 1.30, 95% CI 1.08–1.57, and 1.97, 95% CI 1.44–2.71, respectively). The most common reason for readmission was a gastrointestinal issue among those undergoing both laparoscopic (28.0%) and abdominal surgery (30.2%). Surgical site infection was the most common readmission diagnosis among women undergoing vaginal surgery (16.2%). Of the 418 women readmitted within 7 days of surgery, the most common diagnoses were gastrointestinal issues (26.6%), medical disorders (12.0%), or surgical complications (e.g., bleeding) (11.0%).

Conclusions

Women undergoing laparoscopic or abdominal surgery for pelvic organ prolapse were at higher risk of readmission relative to those undergoing surgery via a vaginal approach. The reasons and timing of readmission differed based on surgical approach.

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References

  1. Wilkins MF, Wu JM. Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse. Minerva Ginecol. 2017;69(2):171–7. https://doi.org/10.23736/S0026-4784.16.04011-9.

    Article  PubMed  Google Scholar 

  2. Bureau USC (2018) An Aging Nation: Projected Number of Children and Older Adults. https://www.census.gov/library/visualizations/2018/comm/historic-first.html. Accessed February 26th 2020.

  3. England K, Azzopardi-Muscat N. Demographic trends and public health in Europe. Eur J Pub Health. 2017;27(suppl_4):9–13. https://doi.org/10.1093/eurpub/ckx159.

    Article  Google Scholar 

  4. Anand M, Weaver AL, Fruth KM, Borah BJ, Klingele CJ, Gebhart JB. Perioperative complications and cost of vaginal, open abdominal, and robotic surgery for apical vaginal vault prolapse. Female Pelvic Med Reconstruct Surg. 2017;23(1):27–35. https://doi.org/10.1097/SPV.0000000000000345.

    Article  Google Scholar 

  5. Lisonkova S, Geoffrion R, Sanaee M, Muraca GM, Wen Q, Yong PJ, Larouche M, Cundiff GW (2020) Regional Variation and Temporal Trends in Surgery for Pelvic Organ Prolapse in Canada, 2004–2014. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. https://doi.org/10.1016/j.jogc.2019.12.016.

  6. Miller BJ, Seman EI, O'Shea RT, Hakendorf PH, Nguyen TTT. Recent trends in the management of pelvic organ prolapse in Australia and New Zealand. Aust N Z J Obstet Gynaecol. 2019;59(1):117–22. https://doi.org/10.1111/ajo.12835.

    Article  PubMed  Google Scholar 

  7. Zacche MM, Mukhopadhyay S, Giarenis I. Trends in prolapse surgery in England. Int Urogynecol J. 2018;29(11):1689–95. https://doi.org/10.1007/s00192-018-3731-2.

    Article  PubMed  Google Scholar 

  8. Gressel GM, Potts JR 3rd, Cha S, Valea FA, Banks E. Hysterectomy route and numbers reported by graduating residents in obstetrics and gynecology training programs. Obstet Gynecol. 2020;135(2):268–73. https://doi.org/10.1097/AOG.0000000000003637.

    Article  PubMed  Google Scholar 

  9. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369(12):1134–42. https://doi.org/10.1056/NEJMsa1303118.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cory L, Latif N, Brensinger C, Zhang X, Giuntoli RL 2nd, Burger RA, et al. Readmission after gynecologic surgery: a comparison of procedures for benign and malignant indications. Obstet Gynecol. 2017;130(2):285–95. https://doi.org/10.1097/AOG.0000000000002141.

    Article  PubMed  Google Scholar 

  11. Penn CA, Morgan DM, Rice LW, Harris JA, Rauh-Hain JA, Uppal S. Timing of and reasons for unplanned 30-day readmission after hysterectomy for benign disease. Obstet Gynecol. 2016;128(4):889–97. https://doi.org/10.1097/AOG.0000000000001599.

    Article  PubMed  Google Scholar 

  12. van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ: Can Med Assoc J (J de l'Assoc Med can). 2011;183(7):E391–402. https://doi.org/10.1503/cmaj.101860.

    Article  Google Scholar 

  13. Hokenstad ED, Glasgow AE, Habermann EB, Occhino JA. Readmission and reoperation after surgery for pelvic organ prolapse. Female Pelvic Med Reconstruct Surg. 2017;23(2):131–5. https://doi.org/10.1097/SPV.0000000000000379.

    Article  Google Scholar 

  14. Shiloach M, Frencher SK Jr, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG, et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210(1):6–16. https://doi.org/10.1016/j.jamcollsurg.2009.09.031.

    Article  PubMed  Google Scholar 

  15. Grimes DA, Schulz KF. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Obstet Gynecol. 2012;120(4):920–7. https://doi.org/10.1097/AOG.0b013e31826af61a.

    Article  PubMed  Google Scholar 

  16. Carter-Brooks CM, Du AL, Ruppert KM, Romanova AL, Zyczynski HM (2018) Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. American journal of obstetrics and gynecology 219 (5):495 e491–495 e410. https://doi.org/10.1016/j.ajog.2018.06.009

  17. Caveney M, Matthews C, Mirzazadeh M. The effect of resident involvement in pelvic prolapse surgery: a retrospective study from a nationwide inpatient sample. Female Pelvic Med Reconstruct Surg. 2017;23(6):387–91. https://doi.org/10.1097/SPV.0000000000000436.

    Article  Google Scholar 

  18. Clancy AA, Ilin J, Pascali D, Shehata F, Hickling DR. Outcomes of an overnight-stay unit for urogynecologic surgery: feasibility and risk factors for failure of next-day discharge. Female Pelvic Med Reconstruct Surg. 2019. https://doi.org/10.1097/SPV.0000000000000750.

  19. Mairesse S, Chazard E, Giraudet G, Cosson M, Bartolo S. Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-019-04210-6.

  20. Unger CA, Hickman LC, Mitchell-Handley B, Barber MD, Ridgeway B. The incidence of perioperative adverse events in the very elderly undergoing urogynecologic surgery. Female Pelvic Med Reconstruct Surg. 2016;22(6):425–9. https://doi.org/10.1097/SPV.0000000000000309.

    Article  Google Scholar 

  21. Dallas K, Elliott CS, Syan R, Sohlberg E, Enemchukwu E, Rogo-Gupta L. Association between concomitant hysterectomy and repeat surgery for pelvic organ prolapse repair in a cohort of nearly 100,000 women. Obstet Gynecol. 2018;132(6):1328–36. https://doi.org/10.1097/AOG.0000000000002913.

    Article  PubMed  Google Scholar 

  22. Dessources K, Hou JY, Tergas AI, Burke WM, Ananth CV, Prendergast E, et al. Factors associated with 30-day hospital readmission after hysterectomy. Obstet Gynecol. 2015;125(2):461–70. https://doi.org/10.1097/AOG.0000000000000623.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee MS, Venkatesh KK, Growdon WB, Ecker JL, York-Best CM. Predictors of 30-day readmission following hysterectomy for benign and malignant indications at a tertiary care academic medical center. Am J Obstet Gynecol. 2016;214(5):607.e601–12. https://doi.org/10.1016/j.ajog.2015.11.037.

    Article  Google Scholar 

  24. Culligan PJ, Kubik K, Murphy M, Blackwell L, Snyder J. A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol. 2005;192(2):422–5. https://doi.org/10.1016/j.ajog.2004.08.010.

    Article  CAS  PubMed  Google Scholar 

  25. Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane reviews. Cochrane Datab Syst Eev. 2018;2:CD012653. https://doi.org/10.1002/14651858.CD012653.pub2.

    Article  Google Scholar 

  26. Brogi E, Kazan R, Cyr S, Giunta F, Hemmerling TM. Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesthesia = J Can D'anesthesie. 2016;63(10):1184–96. https://doi.org/10.1007/s12630-016-0679-x.

    Article  Google Scholar 

  27. Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016;116(2):163–76. https://doi.org/10.1093/bja/aev455.

    Article  CAS  PubMed  Google Scholar 

  28. Longo MA, Cavalheiro BT, de Oliveira Filho GR. Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: systematic review and meta-analyses. J Clin Anesth. 2017;41:48–54. https://doi.org/10.1016/j.jclinane.2017.06.005.

    Article  PubMed  Google Scholar 

  29. Romanova AL, Carter-Brooks C, Ruppert KM, Zyczynski HM. 30-day unanticipated healthcare encounters after prolapse surgery: impact of same day discharge. Am J Obstet Gynecol. 2019. https://doi.org/10.1016/j.ajog.2019.11.1249.

  30. Mueller MG, Elborno D, Dave BA, Leader-Cramer A, Lewicky-Gaupp C, Kenton K. Postoperative appointments: which ones count? Int Urogynecol J. 2016;27(12):1873–7. https://doi.org/10.1007/s00192-016-3052-2.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Dr. Geetha Iyer, MBBS, ScM, and Dr. Ranjeeta Mallick, PhD, for insights regarding statistical analyses.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Ottawa Hospital, Urogynecology Clinic, The Ottawa Hospital Riverside Campus, 1967 Riverside Drive, Ottawa, ON, Canada

    Aisling A. Clancy, Innie Chen & Dante Pascali

  2. T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    Aisling A. Clancy & Vatche A. Minassian

  3. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Innie Chen & Dante Pascali

  4. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Innie Chen & Dante Pascali

  5. Brigham and Women’s Hospital, Boston, MA, USA

    Vatche A. Minassian

Authors
  1. Aisling A. Clancy
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  2. Innie Chen
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  4. Vatche A. Minassian
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Contributions

• Clancy: Protocol/project development, data collection or management, data analysis, data interpretation, manuscript writing/editing.

• Chen: Protocol/project development, data interpretation, manuscript writing/editing.

• Pascali: Data interpretation, manuscript writing/editing.

• Minassian: Protocol/project development, data interpretation, manuscript writing/editing.

Corresponding author

Correspondence to Aisling A. Clancy.

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Conflict of interest

A.A. Clancy, I.Chen and V. Minassian have nothing to disclose. D Pascali has accepted speakers honoraria from Astellas and Pfizer. No funding was obtained for this study.

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Clancy, A.A., Chen, I., Pascali, D. et al. Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using data from the National Surgical Quality Improvement Program Database (NSQIP). Int Urogynecol J 32, 945–953 (2021). https://doi.org/10.1007/s00192-020-04505-z

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  • DOI: https://doi.org/10.1007/s00192-020-04505-z

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