Inflammatory Bowel Disease and Increased Gastrointestinal Complications After Surgery for Pelvic Organ Prolapse

INTRODUCTION: Inflammatory bowel disease (IBD) is characterized by relapsing and remitting inflammation affecting the gastrointestinal (GI) tract, which can lead to intra-abdominal adhesive disease, malnutrition, and immunosuppression; all of which are associated with adverse surgical outcomes, even for non-GI surgery. It is presently unknown if patients undergoing pelvic organ prolapse (POP) surgery are at increased risk of postoperative complications. OBJECTIVE: To compare rates of postoperative complications after POP surgery among patients with and without IBD and evaluate whether an extraperitoneal approach to prolapse repair confers a protective benefit against postoperative complications. METHODS: This was a retrospective cohort study of adult patients who underwent surgery for POP between January 2000 to March 2020 using the Premier U.S. National Database. Apical and non-apical, mesh and native tissue repair were all included. We compared postoperative complications between patients with and without a diagnosis of IBD for at least 1 year preceding their prolapse surgery. The primary outcome was any gastrointestinal complication within 12 months of index surgery. A sub-analysis of intraperitoneal versus extraperitoneal approach to repair was performed. Comparison between patients with and without IBD was accomplished with inverse probability of treatment weighting (IPTW). Multivariable logistic regression was used to identify significant independent associations with GI complications. RESULTS: Among 173,489 POP repairs, 6349 patients had a history of IBD. The rate of postoperative GI complications within 12 months among patients with IBD was 2.9% for any approach and 3.4% among those undergoing intraperitoneal repair. After IPTW matching, not having a diagnosis of IBD was significantly associated with lower risk of postoperative ileus (OR 0.57; 95% CI 0.39–0.83), small bowel obstruction (OR 0.66; 95% CI 0.48–0.9), urinary tract infection (OR 0.61; 95% CI 0.53–0.69), and overall GI complications (OR 0.63; 95% CI 0.49–0.8) at 12 months. In the matched samples, composite GI complications at 12 months remained higher among patients with IBD in both intraperitoneal (3.4% vs. 1.9%, p=0.003) and extraperitoneal approaches (2.6% vs. 1.7%, p= 0.011). On multivariable logistic regression, IBD (OR 2.03; 95% CI 1.67–2.46), abdominal sacrocolpopexy (OR 1.98; 95% CI 1.43–2.73), and laparoscopic sacrocolpopexy (OR 1.21; 92% CI 1.08–1.35) were associated with increased composite GI complication rate. CONCLUSIONS: A diagnosis of IBD is associated with increased risk of postoperative GI complications after prolapse surgery that does not appear to be mitigated by an extraperitoneal approach to POP repair (Tables 1 and 2).