Longitudinal Risk of Apical Prolapse Surgeries

INTRODUCTION: Annually, approximately 200,000 women undergo surgery for pelvic organ prolapse. There are a variety of surgical options for management, including vaginal reconstructive procedures, uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF), and abdominal reconstructive procedures such as sacrocolpopexy (SCP). Despite an increase in surgical management for pelvic organ prolapse, there is a paucity of longitudinal data on recurrence and reoperation for prolapse. Current literature has examined the overall risk of reoperation for apical prolapse surgeries, but there are no studies assessing solely the rate of apical reoperation. Thus, the primary objective of our study was to compare the apical reoperation rates after POP surgery following USLS, SSLF, and SCP in a longitudinal database. OBJECTIVE: Assess the longitudinal risk of apical re-operation for apical prolapse surgeries. METHODS: This is a retrospective cohort study utilizing the TriNetX Research Network platform using years 2006 to 2024. TriNetX is a global federated network of electronic medical record data from 95 health care organizations and provides a de-identified EMR database for up to 128 million patients. We developed cohorts for patient who underwent uterosacral suspensions (USS), sacrospinous suspensions (SSS), and sacral colpopexies (SC). CPT codes were used to identify subjects and included 57280 and 57425 for SC, 57283 for USS, and 57282 for SSS. We excluded subjects <40 years of age, subjects with co-existing genitourinary malignancy or previous bowel surgery and subjects without at least one office visit within 6 months of the index surgery. Our primary outcome measure was the rate of any apical re-operation using the CPT codes above. The TriNetX interface was utilized for a survival analysis. RESULTS: Overall, the rates for apical resuspension were low with 659 out of 14,609 (4.51%) for SSS, 438 out of 23,659 (1.85%) for SC, and 533 out of 16,530 (3.2%) for USS (p<0.01 for all comparisons). The Kaplan–Meier curves for each procedure are shown in Figure 1, with SSS showing the highest rate, followed by USS, then SC (p<0.01 for all comparisons). CONCLUSIONS: Our study suggests that all three apical suspensions are effective repairs for apical pelvic organ prolapse. SC may be a more durable suspension compared to USS or SSS. A strength of our study is the large number of subjects from a wide variety of medical centers over a long time period. Another strength is the focus exclusively on repeat apical suspensions. The study is limited by the administrative nature of the database, the retrospective nature of the study, and the absence of unknown long-term individual follow-up. Because all three procedures are designed only for the suspension of the apex, the exclusion of subsequent repairs to the anterior and posterior compartments gives a clearer measure of the success of these procedures.