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Adverse outcomes after minimally invasive surgery for pelvic organ prolapse in women 65 years and older in the United States

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Abstract

Introduction and hypothesis

To describe complications at the time of surgery, 90-day readmission and 1-year reoperation rates after minimally invasive pelvic organ prolapse (POP) in women > 65 years of age in the US using Medicare 5% Limited Data Set (LDS) Files.

Methods

Medicare is a federally funded insurance program in the US for individuals 65 and older. Currently, 98% of individuals over the age of 65 in the US are covered by Medicare. We identified women undergoing minimally invasive POP surgery, defined as laparoscopic or vaginal surgery, in the inpatient and outpatient settings from 2011–2017. Patient and surgical characteristics as well as adverse events were abstracted. We used logistic regression for complications at index surgery and Cox proportional hazards regression models for time to readmission and time to reoperations.

Results

A total of 11,779 women met inclusion criteria. The mean age was 72 (SD ± 8) years; the majority were White (91%). Most procedures were vaginal (76%) and did not include hysterectomy (68%). The rate of complications was 12%; vaginal hysterectomy (aOR 2.4, 95% CI 2.2–2.7) was the factor most strongly associated with increased odds of complications. The 90-day readmission rate was 7.3%. The most common reason for readmission was infection (2.0%), three quarters of which were urinary tract infections. Medicaid eligibility (aHR 1.5, 95% CI 1.3–1.8) and concurrent sling procedures (aHR 1.2, 95% CI 1.04–1.4) were associated with a higher risk of 90-day readmission. The 1-year reoperation rate was 4.5%. The most common type of reoperation was a sling procedure (1.8%). Obliterative POP surgery (aHR 0.6, 95% CI 0.4–0.9) was associated with a lower risk of reoperation than other types of surgery.

Conclusions

US women 65 years and older who are also eligible to receive Medicaid are at higher risk of 90-day readmission following minimally invasive surgery for POP with the most common reason for readmission being UTI.

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Financial support

NICHD R25-HD094667 AUGS/Duke UrogynCREST (Urogynecology Clinical Research Educational Scientist Training) program

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    C. Emi Bretschneider

  2. Departments of Surgery (Urology) and Population Health Science, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA

    Charles D. Scales Jr

  3. Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA

    Oyomoare Osazuwa-Peters

  4. Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, OH, USA

    David Sheyn

  5. Department Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, RI, USA

    Vivian Sung

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Contributions

CEB: concept development, data analysis, manuscript writing and editing

CDS: concept development, manuscript writing and editing

OOP: data analysis, manuscript editing

DS: manuscript writing and editing

VS: concept development, manuscript writing and editing

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Correspondence to C. Emi Bretschneider.

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Authors do not have any relevant disclosures. C.E.B. is a consultant for Boston Scientific. D.S. is a consultant for Renalis and receives research funding from NICHD.

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Bretschneider, C.E., Scales, C.D., Osazuwa-Peters, O. et al. Adverse outcomes after minimally invasive surgery for pelvic organ prolapse in women 65 years and older in the United States. Int Urogynecol J 33, 2409–2418 (2022). https://doi.org/10.1007/s00192-022-05238-x

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