Long-term reoperation risk after apical prolapse repair in female pelvic reconstructive surgery

• Published in: American journal of obstetrics and gynecology 2022-08, Vol.227 (2), p.306.e1-306.e16
• Main Authors: Shah, Nemi M., Berger, Alexander A., Zhuang, Zimin, Tan-Kim, Jasmine, Menefee, Shawn A.
• Format: Article
• Language: English
• Subjects: gynecologic surgery; pelvic organ prolapse; postoperative complications; prolapse surgery; surgical complications; time factors; treatment failure
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2022.05.046

Although several different apical suspension procedures are available to women with pelvic organ prolapse, data on long-term efficacy and safety profiles are limited. The primary aim of this study was to analyze longitudinal reoperation risk for recurrent prolapse among the 4 apical suspension procedures over 2 to 15 years. Secondary aims included evaluation of all-cause reoperation, defined as a repeated surgery for the indications of recurrent prolapse and adverse events, and total retreatment rate, which included a repeated treatment with another surgery or a pessary. This was a multicenter, retrospective cohort study within Kaiser Permanente Southern California that included women who underwent sacrocolpopexy, uterosacral ligament suspension, sacrospinous ligament fixation, or colpocleisis from January 2006 through December 2018. Women who underwent concomitant rectal prolapse repair or vaginal prolapse repair with mesh augmentation were excluded. Data were abstracted using procedural and diagnostic codes through July 2021, with manual review of 10% of each variable. Patient demographics and pessary use were compared using analysis of variance or chi square tests for continuous and categorical variables, respectively. Time-to-event analysis was used to contrast reoperation rates. A Cox regression model was used to perform an adjusted multivariate analysis of the following predictors of reoperation for recurrence: index surgery, concomitant procedures, patient demographics, baseline comorbidities, and year of index surgery. Censoring events included exit from the health maintenance organization and death. The cohort included 9681 women with maximum follow-up of 14.8 years. The overall incidence of reoperation for recurrent prolapse was 7.4 reoperations per 1000 patient-years, which differed significantly by type of apical suspension (P