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Perioperative outcomes following pelvic floor reconstruction in women with hereditary disorders of connective tissue: a retrospective cohort study

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Abstract

Introduction and hypothesis

Women with hereditary disorders of connective tissue (HDCT) are at increased risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesized that patients would have increased incidence and severity of perioperative complications up to 6 weeks after surgeries for POP/SUI. Secondary objectives were to compare pre- and post-operative pelvic floor symptoms and anatomical support as well as pelvic floor disorder recurrence.

Methods

In this multi-center retrospective cohort study, we identified patients with HDCTs by patient history and ICD-9 codes over an 11-year period. Controls without HDCTs were matched 2:1 to the primary POP or SUI procedure and surgeon. Demographic characteristics, perioperative pelvic floor information and complications were collected. A sample size of 65 HDCT patients and 130 controls was calculated to detect a 20% difference in complications with 80% power and alpha of 0.05.

Results

We identified 59 HDCT patients and 118 controls. Of the women with HDCTs, 49% had Ehlers–Danlos, 22% joint hypermobility syndrome, 15% Marfan syndrome, and 14% had others. Compared with controls, HDCT patients had more total perioperative complications (46% vs 22%, p = 0.002); an age-adjusted relative risk of complications was 1.4 (CI 0.7–2.6). HDCT patients had more Clavien–Dindo grades I and II complications (p = 0.02, 0.03) and more hospital readmissions (14% vs 3%, p = 0.01) than controls. There was no difference in the incidence of specific complications nor was there a difference in recurrence of POP (10%) or SUI (11%) between groups.

Conclusions

Patients with HDCTs had more Clavien–Dindo grade I and II complications following pelvic floor reconstructive surgery and more readmissions.

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Acknowledgements

The authors wish to thank the Fellows Pelvic Research Network (FPRN®) Steering Committee and the Advisory Board in their support of this work.

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Authors and Affiliations

  1. Cleveland Clinic, Cleveland, OH, USA

    Emily R. W. Davidson

  2. Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Emily R. W. Davidson

  3. MedStar Washington Hospital Center/Georgetown University, Washington, DC, USA

    Pakeeza A. Alam, Eshetu A. Tefera & Robert E. Gutman

  4. Mayo Clinic, Rochester, MN, USA

    Jenifer N. Byrnes

  5. Northwestern University, Chicago, IL, USA

    Katarzyna Bochenska

  6. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Maria Florian-Rodriguez

  7. University of Pittsburgh Medical Center/Magee Womens Hospital, Pittsburgh, PA, USA

    Charelle M. Carter-Brooks

  8. Greater Baltimore Medical Center, Baltimore, MD, USA

    Emily N. B. Myer

  9. University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA

    Meadow M. Good

Authors
  1. Emily R. W. Davidson
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  2. Pakeeza A. Alam
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  3. Jenifer N. Byrnes
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  4. Katarzyna Bochenska
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  5. Maria Florian-Rodriguez
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  7. Emily N. B. Myer
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  9. Meadow M. Good
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Contributions

ERW Davidson: Data collection, manuscript writing/editing

P Alam: Protocol/project development, data collection/management, data analysis, manuscript writing/editing

J Byrnes: Data collection

K Bochenska: Data collection

M Florian-Rodriguez: Data collection

CM Carter-Brooks: Data collection

E Myer: Data collection

EA Tefera: Data analysis

MM Good: Project development

RE Gutman: Project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Emily R. W. Davidson.

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Conflicts of interest

Robert E. Gutman: Boston Scientific research grant (site principal investigator for Uphold LITE 522 FDA trials and investigator initiated grant, consultant, strategic advisory board member); Johnson and Johnson: expert witness sling class action lawsuits. The remaining authors declare that they have no conflicts of interest.

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Davidson, E.R.W., Alam, P.A., Byrnes, J.N. et al. Perioperative outcomes following pelvic floor reconstruction in women with hereditary disorders of connective tissue: a retrospective cohort study. Int Urogynecol J 32, 2135–2142 (2021). https://doi.org/10.1007/s00192-021-04893-w

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  • DOI: https://doi.org/10.1007/s00192-021-04893-w

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