Postoperative Complications of Posterior Repair at Time of Sacrolcopopexy

INTRODUCTION: Each year, many patients presenting with symptomatic female pelvic organ prolapse elect for minimally invasive surgical repair with sacrocolpopexy (SCP) and concurrent hysterectomy (MIH). Presently, there is no standardization around the need for a concurrent level III support procedure such as posterior repair (PR) at the time of SCP. The decision for PR at the time of MIH-SCP is often made due to patient-specific factors such as symptomatic posterior compartment prolapse. Emerging data shows that PR may be protective against recurrence even for asymptomatic posterior compartment prolapse. There is little data available on the rate of postoperative complications comparing MIH-SCP with PR versus those without. OBJECTIVE: To determine the difference in postoperative complications associated with concurrent PR at the time of MIH-SCP for pelvic organ prolapse. METHODS: Patients undergoing minimally invasive MIH-SCP with and without concurrent PR were identified in the National Surgical Quality Improvement Program (NSQIP) Database between the years of 2019 and 2022 using Current Procedural Terminology (CPT) codes. Patients whose American Society of Anesthesiologists (ASA) class was not recorded and participants with missing values for age, height, weight, or operative time were excluded. Descriptive statistics were used to describe the overall cohort. Concurrent procedures were identified. Minimally invasive hysterectomy included total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy (SCH), laparoscopic-assisted vaginal hysterectomy (LAVH), and total vaginal hysterectomy (TVH). The primary outcome was any 30-day adverse event, which was defined as a composite outcome including any NSQIP tracked postoperative complication, readmission, or reoperation. Secondary outcomes included any 30-day postoperative complication, major complications, minor complications, reoperation, and readmission. Differences in patient characteristics and outcomes for concurrent PR versus none were described using chi-square and t-tests where appropriate. Logistic regression analyses were performed to determine odds of undergoing concurrent PR based on mode of MIH-SCP, controlling for route of MIH, age, body mass index (BMI), operative time, and ASA class. RESULTS: In total, 7,690 patients were identified. The mean age was 56, most patients identified as White (80%) with an ASA class of 2 (723%) and the mean BMI was 30 kg/m2. Of concurrent procedures, the rate of PR during SCP (20%) was second only to mid-urethral sling (38%). Of concurrent hysterectomy at time of SCP, TLH was the most common route of MIH (56%), followed by laparoscopic SCH (39%), TVH (3%), and LAVH (2%). The rate of any 30-day adverse event was 10% and any 30-day postoperative complication was 9%, with no significant differences between the concurrent PR and no PR group. The most common postoperative complication was UTI (2%). On multivariable logistic regression controlling for confounders, compared with TLH, SCP with concurrent SCH was associated with 15% increased odds of concurrent PR (aOR 1.15, 95% CI 1.0, 1.3). CONCLUSIONS: Concurrent PR at the time of MIH-SCP is not associated with a higher rate of 30-day postoperative complications or overall adverse events. Controlling for age, operative time, ASA class, BMI, and smoking status, odds of undergoing PR was highest in patients undergoing SCH-SCP (Tables 1 and 2).