Abstract
Objective
To determine if graft augmentation with anterior colporrhaphy (AC+G) is associated with higher complication rates compared to native tissue repair (AC).
Materials and methods
Retrospective cohort study using data from the ACS-NSQIP database between 2010 and 2017. CPT codes were used to identify women undergoing AC+G and AC. Propensity scores for the likelihood of undergoing AC+G were calculated and were used to match to women undergoing native tissue repair at a ratio of 1:2. The primary outcome was the composite complication rate. Descriptive statistics are reported as means with standard deviations for parametric data and as medians and interquartile ranges for non-parametric data. Pairwise comparisons were performed using Fisher’s exact test, Wilcoxon rank-sum and Student’s t test as appropriate. Multivariable logistic regression was then used to adjust for confounders to identify statistically significant factors associated with the likelihood of experiencing a complication after prolapse repair.
Results
582 women met inclusion criteria for AC+G and were matched with 1164 women undergoing AC. There were no differences in preoperative characteristics between groups. There was no difference in the composite complication rate, (10.8% vs. 8.5%, p = 0.13) between groups. Dependent functional status (aOR 4.31, 95% CI 1.96–13.58) was the strongest predictor of the likelihood of a complication: other significant predictors were operating time greater than 20 min (aOR 1.68, 95% CI 1.19–2.38) and ASA class greater than 2 (aOR 1.44, 95% CI 1.01–2.05).
Conclusion
There is no increase in 30-day complication rates in women undergoing AC+G compared to a matched cohort of those undergoing AC alone.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jacklin P, Duckett J (2013) A decision-analytic Markov model to compare the cost–utility of anterior repair augmented with synthetic mesh compared with non-mesh repair in women with surgically treated prolapse. BJOG Int J Obstet Gynaecol 120:217–223. https://doi.org/10.1111/1471-0528.12028
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic-organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506
Kirby AC, Luber KM, Menefee SA (2013) An update on the current and future demand for care of pelvic floor disorders in the United States. Am J Obstet Gynecol 209(6):584-e1
Eilber KS, Alperin M, Khan A et al (2013) Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support. Obstet Gynecol 122(5):981–987. https://doi.org/10.1097/AOG.0b013e3182a8a5e4
Stewart JR, Hamner JJ, Heit MH (2016) Thirty years of cystocele/rectocele repair in the United States. Female Pelvic Med Reconstr Surg 22(4):243–247
Sheyn D, El-Nashar S, Mahajan ST, Mangel JM, Chapman GC, Hijaz AK (2020) Apical suspension utilization at the time of vaginal hysterectomy for pelvic organ prolapse varies with surgeon specialty. Female Pelvic Med Reconstr Surg 26(6):370–375
Sammarco AG, Swenson CW, Kamdar NS, Kobernik EK, DeLancey JO, Nallamothu B, Morgan DM (2018) Rate of pelvic organ prolapse surgery among privately insured women in the United States, 2010–2013. Obstet Gynecol 131(3):484–492
Bohlin KS, Ankardal M, Nüssler E, Lindkvist H, Milsom I (2018) Factors influencing the outcome of surgery for pelvic organ prolapse. Int Urogynecol J 29(1):81
Eilber KS, Alperin M, Khan A, Wu N, Pashos CL, Clemens JQ, Anger JT (2017) The role of the surgeon on outcomes of vaginal prolapse surgery with mesh. Female Pelvic Med Reconstr Surg 23(5):293–296
Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J (2016) Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev 11(11):CD004014. https://doi.org/10.1002/14651858.CD004014.pub6(Published 2016 Nov 30)
Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004014.pub5
Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364(19):1826–1836
Carey M, Higgs P, Goh J et al (2009) Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG 116(10):1380–1386. https://doi.org/10.1111/j.1471-0528.2009.02254.x
Withagen M, Milani A, de Leeuw J, Vierhout M (2012) Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG Int J Obstet Gynaecol 119:354–360. https://doi.org/10.1111/j.1471-0528.2011.03231.x
Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidence based literature review. Int Urogynecol J 17(2):195–201
Caveney M, Haddad D, Matthews C, Badlani G, Mirzazadeh M (2017) Short-term complications associated with the use of transvaginal mesh in pelvic floor reconstructive surgery: results from a multi-institutional prospectively maintained dataset. Neurourol Urodyn 36(8):2044–2048
Theofanides MC, Onyeji I, Matulay J, Sui W, James M, Chung DE (2017) Safety of mesh for vaginal cystocele repair: analysis of national patient characteristics and complications. J Urol 198(3):632–637
Fink AS, Campbell DA Jr, Mentzer RM Jr, Henderson WG, Daley J, Bannister J, Hur K, Khuri SF (2002) The national surgical quality improvement program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg 236(3):344
Nayan M, Hamilton RJ, Juurlink DN, Finelli A, Kulkarni GS, Austin PC (2017) Critical appraisal of the application of propensity score methods in the urology literature. BJU Int 120(6):873–880. https://doi.org/10.1111/bju.13930
Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10(2):150–161. https://doi.org/10.1002/pst.433
Austin PC (2010) Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol 172(9):1092–1097. https://doi.org/10.1093/aje/kwq224
Cundiff GW (2019) Surgical innovation and the US food and drug administration. Female Pelvic Med Reconstr Surg 25(4):263–264
Funding
None.
Author information
Authors and Affiliations
Contributions
DS: project development, data collection and analysis, manuscript writing. RD: project development, manuscript writing. AD: manuscript writing. GC: manuscript writing. ES: manuscript writing. AD: manuscript writing.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This study utilized data from a national surgical registry and did not directly involve human participants.
Informed consent
Informed consent was not required for this research as this study did not directly involve human subjects.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Darvish, R., Davenport, A., Dao, A. et al. Evaluation of 30-day complication rates following vaginal anterior compartment repair with and without graft augmentation in a propensity score matched cohort. World J Urol 39, 2191–2196 (2021). https://doi.org/10.1007/s00345-020-03360-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-020-03360-3