Surgical Management of Pelvic Floor Disorders and the Utility of Preoperative Labs

INTRODUCTION: Current national guidelines advise against routine preoperative laboratory testing to assess risk of perioperative events prior to surgery. Despite these recommendations to perform testing on a selective basis, many patients undergo unnecessary testing prior to surgery for pelvic floor disorders (PFDs). OBJECTIVE: To determine the clinical utility of preoperative laboratory assessment prior to surgical management of PFDs. Secondary objectives were to identify rates of case cancellation or postponement due to lab abnormalities and factors associated with preoperative lab testing. METHODS: A retrospective study was performed of all surgeries within the Department of Urogynecology and Reconstructive Pelvic Surgery (URPS) at a single academic medical center between January 1, 2021, and December 31, 2024. Patient demographics, clinical characteristics, and preoperative laboratory assessments were abstracted from the medical record. Preoperative labs included type and screen, complete blood count (CBC), and basic or complete metabolic panel. Hemoglobin <10 mg/dL, platelet count <100 ×103/mL, creatinine >1.0 mg/dL, sodium <135 mEq/L, potassium <3.6 mEq/L, or glucose >200 mg/mL were a priori categorized as clinically meaningful lab abnormalities. Case cancellation or postponement due to a preoperative lab abnormality was documented. Surgical cases were divided into major and minor procedures. Major procedures included hysterectomy, apical suspension, and colpocleisis. Minor procedures included midurethral sling, sacral neuromodulation, intravesical botox, isolated anterior and/or posterior repair, and cystoscopy. Group comparisons were performed using Student’s t-test and chi-squared Fisher’s exact test for continuous and categorical variables. Backwards logistic regression was performed to determine factors independently associated with preoperative lab testing after controlling for potential confounding variables. Variables with a p<0.10 on bivariate analysis were included. RESULTS: Six hundred thirty-four surgeries were performed for PFDs during the study period. Baseline demographics of the cohort were obtained. 469 (74%) had preoperative labs performed. CBC accounted for nearly 2/3 of preoperative testing. Clinically meaningful lab abnormalities were rare and did not result in any changes to the surgical plan or timing. Patients with diabetes mellitus were more likely to have preoperative labs (p=0.02); otherwise, medical comorbidities were similar between cohorts. Patients who had preoperative labs were more likely to have a hysterectomy (p<0.001), sacrocolpopexy (p=0.004), uterosacral ligament suspension (p=0.001), anterior repair (p<0.001), and posterior repair (p<0.001) than those without preoperative labs. After controlling for potential confounding variables (race, insurance, diabetes mellitus, coronary artery disease, hysterectomy, sacrocolpopexy, uterosacral ligament suspension, anterior repair, posterior repair, and surgery type), Black race (aOR 2.29), preoperative diabetes mellitus (aOR 2.12), and major surgery (aOR 1.78) increased odds of preoperative laboratory testing. CONCLUSIONS: Despite the majority of patients undergoing preoperative laboratory testing, clinically meaningful abnormalities were rare and did not change surgical management. Policies and procedures surrounding preoperative testing should be re-evaluated to reflect current national guidelines (Tables 1 and 2).