AIMS: Minimally invasive sacrocolpopexy (MISC) has gained widespread acceptance without randomized or population-based data to support its use.
This study compares 30-day outcomes after MISC and open sacrocolpopexy (OSC) using population-based data.
METHODS: The National Surgical Quality Improvement Program (NSQIP) database was used to acquire 1,786 sacrocolpopexy operations (659 OSC and 1,127 MISC) performed from 2005 to 2011. A propensity-weighted comparative analysis of perioperative morbidity was performed.
RESULTS: Among women undergoing sacrocolpopexy, the proportion of MISC procedures increased from 7.1% in 2006 to 68.8% in 2011. Women undergoing OSC were older (P < 0.001) and had somewhat higher American Society of Anesthesiologists classifications (P = 0.11). Unadjusted comparisons between groups revealed higher rates of superficial (P < 0.001) and deep surgical (P = 0.009) site infections in the OSC group. There was also a higher rate of blood transfusions (P = 0.02), a longer length of hospitalization (P < 0.001), and a shorter operative time (P < 0.001) among patients undergoing OSC. In the propensity-weighted analysis, MISC was associated with lower rates of wound infections (1.1% vs. 3.0%; P = 0.01), lower blood transfusion rates (0.7% vs. 2.3%; P = 0.01), a shorter mean hospitalization (1.4 vs. 3.0 days; P < 0.001), and a longer mean operative time (224.8 vs. 188.6 min; P < 0.001). No differences were noted among renal, infectious, or neurologic complications, although pulmonary complications were higher in the OSC group (0.3% vs. 1.0%; P = 0.08). No differences in 30-day mortality were noted (0.1% vs. 0.2%; P = 0.61).
CONCLUSIONS: MISC was associated with lower perioperative morbidity in this propensity-weighted analysis.
Written by:
Tyson MD, Wolter CE. Are you the author?
Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona.
Reference: Neurourol Urodyn. 2013 Nov 22. Epub ahead of print.
doi: 10.1002/nau.22522
PubMed Abstract
PMID: 24265258
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