Top

International Urogynecology Journal

Published in:

01-11-2019 | Vaginal Surgery | Original Article

Incidence and contributing factors of perioperative complications in surgical procedures for pelvic organ prolapse

Authors: Hanan Alshankiti, Sara Houlihan, Magali Robert, Calgary Women’s Pelvic Health Research Group

Published in: International Urogynecology Journal | Issue 11/2019

Abstract

Background

Data on the incidence of perioperative complications of surgical procedures for pelvic organ prolapse (POP) and their contributing factors are limited, sometimes conflicting, and often mixed with other urogynecologic surgeries.

Objectives

To estimate the incidence and contributing factors for perioperative complications of POP procedures.

Methods

A cross-sectional study was carried out between November 2016 and June 2017. POP procedures of different approaches were included irrespective of the surgeon involved, type of surgery (primary or repeat), or concomitant hysterectomy or incontinence repair. Data on perioperative complications were recorded prospectively.

Results

A total of 366 women were included in the current analysis. The average age was 61.0 ± 13.4 years. The surgical procedures performed were vaginal (75.3%), abdominal (11.3%), or combined (13.4%). Approximately 18.2% of these procedures were repeat surgeries. A total of 38 (11.3%) women developed perioperative complications (3.6% severe and 7.7% minor). These included: 25 (7.4%) intraoperative complications (2.4% severe and 5.1% minor) and 17 (5.1%) postoperative complications (2.1% severe and 3.0% minor). In multivariate analysis, abdominal surgery and McCall culdoplasty were significant predictors of intraoperative complications (alone or when combined with other postoperative complications). On the other hand, concomitant hysterectomy and concomitant incontinence repair procedure were associated with higher postoperative complication rates while vaginal surgery had fewer postoperative complications.

Conclusion

There was a low rate of perioperative complications. Abdominal surgery and McCall culdoplasty showed higher intraoperative complications. These data should help in preoperative counseling and target ways to further decrease complication rates.

Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.CrossRef

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.CrossRef

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.CrossRef

Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127–35.CrossRef

Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396–403.CrossRef

Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.CrossRef

Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.CrossRef

Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003;188(1):108–15.CrossRef

Boyles SH, Weber AM, Meyn L. Procedures for urinary incontinence in the United States, 1979-1997. Am J Obstet Gynecol. 2003;189(1):70–5.CrossRef

10.

Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–501. discussion 1501-1493.CrossRef

11.

Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The collaborative review of sterilization. Am J Obstet Gynecol. 1982;144(7):841–8.CrossRef

12.

Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S. Predicting risk of complications with gynecologic laparoscopic surgery. Obstet Gynecol. 1998;92(3):327–31.PubMed

13.

Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50(11):795–805.CrossRef

14.

Lambrou NC, Buller JL, Thompson JR, Cundiff GW, Chou B, Montz FJ. Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery. Am J Obstet Gynecol. 2000;183(6):1355–8. discussion 1359-1360.CrossRef

15.

Cengiz H, Dagdeviren H, Kaya C, Helvacoğlu Ç, Ekin M. Perioperative complications of urogynecologic surgery: our experience in a tertiary care hospital. Gynecol Obstet Reprod Med. 2017:1–3.

16.

Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol. 2005;192(5):1630–6.CrossRef

17.

Bohlin KS, Ankardal M, Nussler E, Lindkvist H, Milsom I. Factors influencing the outcome of surgery for pelvic organ prolapse. Int Urogynecol J. 2018;29(1):81–9.CrossRef

18.

Erekson E, Murchison RL, Gerjevic KA, Meljen VT, Strohbehn K. Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am J Obstet Gynecol. 2017;217(5):608 e601–17.CrossRef

19.

Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22(1):3–15.CrossRef

20.

Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Neurourol Urodyn. 2012;31(4):415–21.CrossRef

21.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRef

22.

Al-Kadri HM, Al-Turki HA, Saleh AM. Short and long-term complications of abdominal and vaginal hysterectomy for benign disease. Saudi Med J. 2002;23(7):806–10.PubMed

23.

van der Ploeg JM, van der Steen A, Oude Rengerink K, van der Vaart CH, Roovers JP. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121(5):537–47.CrossRef

24.

Schiavi MC, Savone D, Di Mascio D, Di Tucci C, Perniola G, Zullo MA, et al. Long-term experience of vaginal vault prolapse prevention at hysterectomy time by modified McCall culdoplasty or Shull suspension: clinical, sexual and quality of life assessment after surgical intervention. Eur J Obstet Gynecol Reprod Biol. 2018;223:113–8.CrossRef

25.

Spelzini F, Frigerio M, Manodoro S, Interdonato ML, Cesana MC, Verri D, et al. Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study. Int Urogynecol J. 2017;28(1):65–71.CrossRef

26.

Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11–26. e13.CrossRef

27.

Nam KH, Jeon MJ, Hur HW, Kim SK, Bai SW. Perioperative and long-term complications among obese women undergoing vaginal surgery. Int J Gynaecol Obstet. 2010;108(3):244–6.CrossRef

28.

Chen CC, Collins SA, Rodgers AK, Paraiso MF, Walters MD, Barber MD. Perioperative complications in obese women vs normal-weight women who undergo vaginal surgery. Am J Obstet Gynecol. 2007;197(1):98 e91–8.CrossRef

Title: Incidence and contributing factors of perioperative complications in surgical procedures for pelvic organ prolapse
Authors: Hanan Alshankiti
Sara Houlihan
Magali Robert
Calgary Women’s Pelvic Health Research Group
Publication date: 01-11-2019
Publisher: Springer International Publishing
Keywords: Vaginal Surgery
Hysterectomy
Published in: International Urogynecology Journal / Issue 11/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-03873-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Incidence and contributing factors of perioperative complications in surgical procedures for pelvic organ prolapse

Abstract

Background

Objectives

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2019

Variation in bony landmarks and predictors of success with sacral neuromodulation

Prevalence of metabolic syndrome and its components in women with and without pelvic organ prolapse and its association with prolapse severity according to the Pelvic Organ Prolapse Quantification system

Female lower urinary tract microbiota do not associate with IC/PBS symptoms: a case-controlled study

Severity and bother of prolapse symptoms in women with pelvic floor myofascial pain

Intraocular pressure change during laparoscopic sacral colpopexy in patients with normal tension glaucoma

Commentary on ‘Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques’