Hunt Fiona J, Holman C D'Arcy J, Einarsdottir Kristjana, Moorin Rachael E, Tsokos Nicolas
Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia,
Int Urogynecol J. 2013 Dec;24(12):2031-8. doi: 10.1007/s00192-013-2149-0. Epub 2013 Jun 26.
We previously described a declining rate of surgery in the treatment of pelvic organ prolapse (POP) in Western Australia. This paper builds on previous work by examining temporal trends and the post-operative risk of in-hospital complications, following first time incident prolapse surgery in a population-based cohort of women.
We investigated rates of prolapse surgery between 1988 and 2005 according to age group and concomitant procedure type for 34,509 women whose data were extracted from the WA Data Linkage System. We investigated changes over time in the demographic characteristics of women undergoing surgery and whether the presence of selected concomitant procedures increased the risk of in-hospital complications.
During the study period, 34,509 women underwent an incident surgery for POP. Concomitant hysterectomy was performed in more than half of all surgeries (52.4 %) and a concomitant urinary incontinence (UI) surgery was noted in 25.8 %. 10.9 % of patients experienced a complication of interest, with the highest percentage of complications recorded in women who underwent multi-concomitant surgery. After controlling for age, comorbidity and time period we found that concomitant UI surgery increases in-hospital complications (OR 1.61 95 % CI 1.42-1.83) only in women who have a repair procedure (colporrhaphy and/or enterocele repair). There was no significant effect of concomitant procedures in women who underwent a combined repair and apical prolapse procedure.
Surgery to treat prolapse is common, has low mortality and concomitant surgery only increases complications when combined with simpler prolapse surgery.
我们之前曾描述过西澳大利亚州盆腔器官脱垂（POP）治疗中手术率的下降情况。本文基于之前的研究工作，对基于人群队列的女性首次发生脱垂手术后的时间趋势及院内并发症的术后风险进行了研究。
我们根据年龄组和伴随手术类型，调查了1988年至2005年间从西澳大利亚州数据链接系统提取数据的34509名女性的脱垂手术率。我们研究了接受手术女性的人口统计学特征随时间的变化，以及所选伴随手术的存在是否会增加院内并发症的风险。
在研究期间，34509名女性接受了首次POP手术。超过一半的手术（52.4%）同时进行了子宫切除术，25.8%的手术同时进行了尿失禁（UI）手术。10.9%的患者出现了感兴趣的并发症，在接受多种伴随手术的女性中并发症发生率最高。在控制年龄、合并症和时间段后，我们发现只有在进行修复手术（阴道修补术和/或肠膨出修补术）的女性中，同时进行UI手术会增加院内并发症（比值比1.61，95%置信区间1.42 - 1.83）。在接受联合修复和顶端脱垂手术的女性中，伴随手术没有显著影响。
治疗脱垂的手术很常见，死亡率低，只有在与更简单的脱垂手术联合时，伴随手术才会增加并发症。
