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International Urogynecology Journal

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01-12-2016 | Original Article

Postoperative appointments: which ones count?

Authors: Margaret G. Mueller, Dana Elborno, Bhumy A. Davé, Alix Leader-Cramer, Christina Lewicky-Gaupp, Kimberly Kenton

Published in: International Urogynecology Journal | Issue 12/2016

Abstract

Introduction and hypothesis

Although postoperative complications in women undergoing reconstructive pelvic surgery (RPS) have been characterized, little is known regarding the timeline of these occurrences. We aimed to determine the timeframe after RPS during which the majority of complications occur, to assist with planning intervals between postoperative visits.

Methods

Women undergoing RPS were identified through billing information. Demographic, surgical, and complications data were extracted from electronic medical records.

The Pelvic Floor Complication scale is a surgical scale tailored to women undergoing RPS. It contains three subscales: intraoperative, immediately postoperative, and delayed complications. We applied this scale to each postoperative visit (at 2, 6, and 13 weeks).

Results

396 women underwent RPS and 125 patients had 179 complications, most of which (66 %) were identified by the 2-week visit. Complications at the 2-week visit consisted of urinary tract infection (UTI; 46 %), wound infection (10.0 %), and urinary retention (9.4 %). The majority of serious complications (venous thromboembolism [VTE], ileus, small bowel obstruction [SBO], readmission, and reoperation [1 incarcerated hernia and 1 sling release]) were diagnosed by 2 weeks. One patient was readmitted for ileus at between 2 and 6 weeks. At between 6 and 13 weeks, 1 patient was readmitted with SBO; 1 VTE was diagnosed; and 1 required reoperation for a prolapsed fallopian tube. In contrast, two thirds of the complications seen at the 13-week visit were due to granulation tissue, suture erosion or mesh erosion.

Conclusions

The majority of non-mesh-related complications occur within the first 2 weeks after RPS, whereas mesh and suture complications are more likely to be identified at the 13-week visit.

Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B (2014) Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol 211(5):547.e1–547.e8CrossRef

Unger CA, Walters MD, Ridgeway B, Jelovsek JE, Barber MD, Paraiso MF (2015) Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am J Obstet Gynecol 212(5):603.e1–603.e7CrossRef

Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M et al (2013) Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA: J Am Med Assoc 309(19):2016–2024CrossRef

Mueller MG (2016) When do we see our postoperative patients? Am J Obstet Gynecol 214(4):S505–S506CrossRef

Woelk JL, Borah BJ, Trabuco EC, Heien HC, Gebhart JB (2014) Cost differences among robotic, vaginal, and abdominal hysterectomy. Obstet Gynecol 123(2 Pt 1):255–262CrossRefPubMedPubMedCentral

Scott AR, Rush AJ 3rd, Naik AD, Berger DH, Suliburk JW (2015) Surgical follow-up costs disproportionately impact low-income patients. J Surg Res 199(1):32–38CrossRefPubMed

Committee on Practice Bulletins—Gynecology ACoO, Gynecologists (2007) ACOG Practice Bulletin no. 84: prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol 110(2 Pt 1):429–440

Bulletins—Gynecology ACoP (2009) ACOG Practice Bulletin no. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 113(5):1180–1189

Gutman RE, Nygaard IE, Ye W, Rahn DD, Barber MD, Zyczynski HM et al (2013) The Pelvic Floor Complication Scale: a new instrument for reconstructive pelvic surgery. Am J Obstet Gynecol 208(1):81.e1–81.e9CrossRef

10.

Brubaker L, Norton PA, Albo ME, Chai TC, Dandreo KJ, Lloyd KL et al (2011) Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol 205(5):498.e1–498.e6CrossRef

11.

Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354(15):1557–1566CrossRefPubMed

12.

Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE et al (2007) Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 356(21):2143–2155CrossRefPubMed

13.

Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT et al (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362(22):2066–2076CrossRefPubMedPubMedCentral

14.

Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K et al (2012) A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 366(25):2358–2367CrossRefPubMedPubMedCentral

15.

Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC et al (2014) Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 311(10):1023–1034CrossRefPubMedPubMedCentral

16.

Sutkin G, Alperin M, Meyn L, Wiesenfeld HC, Ellison R, Zyczynski HM (2010) Symptomatic urinary tract infections after surgery for prolapse and/or incontinence. Int Urogynecol J 21(8):955–961CrossRefPubMed

17.

Solomon ER, Frick AC, Paraiso MF, Barber MD (2010) Risk of deep venous thrombosis and pulmonary embolism in urogynecologic surgical patients. Am J Obstet Gynecol 203(5):510.e1–510.e4CrossRef

18.

Burgio KL, Brubaker L, Richter HE, Wai CY, Litman HJ, France DB et al (2010) Patient satisfaction with stress incontinence surgery. Neurourol Urodyn 29(8):1403–1409CrossRefPubMedPubMedCentral

19.

Wolters JP, King AB, Rapp DE (2014) Satisfaction in patients undergoing concurrent pelvic floor surgery for stress urinary incontinence and pelvic organ prolapse. Female Pelvic Med Reconstr Surg 20(1):23–26CrossRefPubMed

20.

Mahajan ST, Elkadry EA, Kenton KS, Shott S, Brubaker L (2006) Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol 194(3):722–728CrossRefPubMed

21.

Lowenstein L, FitzGerald MP, Kenton K, Dooley Y, Templehof M, Mueller ER et al (2008) Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 19(1):81–84CrossRefPubMed

Title: Postoperative appointments: which ones count?
Authors: Margaret G. Mueller
Dana Elborno
Bhumy A. Davé
Alix Leader-Cramer
Christina Lewicky-Gaupp
Kimberly Kenton
Publication date: 01-12-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 12/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-016-3052-2

At a glance: The STEP trials

Springer Medicine

Postoperative appointments: which ones count?

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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