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Evaluation of gastrointestinal tract injury within 1 year of surgery for pelvic organ prolapse

International Urogynecology Journal (2023)Cite this article

Abstract

Objective

To identify the incidence and risk factors of gastrointestinal injury (GITI) related to pelvic organ prolapse (POP) surgery.

Methods

Women who underwent POP surgery between 2000 and 2020 were identified in the Premier Healthcare Database. The primary outcome was GITI, defined as small or large bowel injury or repair, and fistula or fistula repair. Differences between patients with and without GITI were evaluated, and a multivariable regression was performed to determine independent predictors of GITI.

Results

We identified 563,661 index POP surgeries in female patients aged 18 years and older. Of these, 4582 (0.8%) had a bowel injury code within 1 year of index POP surgery. Patients who experienced GITI were more likely to be younger (49.9 ± 12.8 vs 50.9 ± 13.7), and receive surgery with a surgeon who performed less than 12 surgeries per year (48% vs 42%). Most GITI was diagnosed in the same month (73.4%) and same hospital encounter (54%) as index POP surgery. After adjusting for confounders, lysis of adhesions (aOR = 2.03, 95% CI: 1.48–2.72) and perioperative hematoma/hemorrhage (aOR = 2.87, 95%C I: 1.70–4.59) were strongly associated with GITI, while having surgery with a surgeon performing > 50 POP surgeries per year (aOR = 0.66, 95%C I: 0.59–0.75 and concomitant obliterative procedures (aOR = 0.48, 95% CI: 0.34–0.65) were associated with a lower probability of GITI.

Conclusions

The rate of GITI after POP surgery is less than 1%, and injuries are commonly diagnosed and treated in the same month as index surgery. High-volume surgeons and obliterative procedures may be protective against GITI.

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Acknowledgements

The abstract for this manuscript has been accepted as a non-oral poster at the Society for Gynecologic Surgeons Annual Meeting in Tucson, AZ, USA to be held in March 2023.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville Health, 4331 Churchman Avenue, Louisville, KY, 40215, USA

    Ankita Gupta

  2. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA

    C. Emi Bretschneider

  3. Urology Institute, University Hospitals, Cleveland, OH, USA

    Stephen Rhodes

  4. Division of Urologic Oncology, Urology Institute, University Hospitals, Cleveland, OH, USA

    Jonathan Shoag

  5. Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN, USA

    Cathrine McBride

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

    David Sheyn

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  1. Ankita Gupta
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  2. C. Emi Bretschneider
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  3. Stephen Rhodes
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  4. Jonathan Shoag
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Contributions

A Gupta: Project development, manuscript writing/editing.

CE Bretschneider: Project development, manuscript editing.

S Rhodes: Data analysis, manuscript editing.

J Shoag: Project development, manuscript editing.

C McBride: Project development, manuscript editing.

D Sheyn: Project development, manuscript writing/editing.

Corresponding author

Correspondence to Ankita Gupta.

Ethics declarations

Conflicts of interest

A Gupta: None.

CE Bretschneider: Consultant for Boston Scientific.

S Rhodes: None.

J Shoag: None.

C McBride: None.

D Sheyn: research funding: Renalis, NICHD, AHRQ; consulting fee: Caldera Medical.

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Gupta, A., Bretschneider, C.E., Rhodes, S. et al. Evaluation of gastrointestinal tract injury within 1 year of surgery for pelvic organ prolapse. Int Urogynecol J (2023). https://doi.org/10.1007/s00192-023-05503-7

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  • DOI: https://doi.org/10.1007/s00192-023-05503-7

Keywords

  • Pelvic organ prolapse
  • Gastrointestinal injury
  • Hysterectomy
  • Apical suspension