Tyson Mark D, Wolter Christopher E
Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona.
Neurourol Urodyn. 2015 Feb;34(2):151-5. doi: 10.1002/nau.22522. Epub 2013 Nov 22.
Minimally invasive sacrocolpopexy (MISC) has gained widespread acceptance without randomized or population-based data to support its use. This study compares 30-day outcomes after MISC and open sacrocolpopexy (OSC) using population-based data.
The National Surgical Quality Improvement Program (NSQIP) database was used to acquire 1,786 sacrocolpopexy operations (659 OSC and 1,127 MISC) performed from 2005 to 2011. A propensity-weighted comparative analysis of perioperative morbidity was performed.
Among women undergoing sacrocolpopexy, the proportion of MISC procedures increased from 7.1% in 2006 to 68.8% in 2011. Women undergoing OSC were older (P < 0.001) and had somewhat higher American Society of Anesthesiologists classifications (P = 0.11). Unadjusted comparisons between groups revealed higher rates of superficial (P < 0.001) and deep surgical (P = 0.009) site infections in the OSC group. There was also a higher rate of blood transfusions (P = 0.02), a longer length of hospitalization (P < 0.001), and a shorter operative time (P < 0.001) among patients undergoing OSC. In the propensity-weighted analysis, MISC was associated with lower rates of wound infections (1.1% vs. 3.0%; P = 0.01), lower blood transfusion rates (0.7% vs. 2.3%; P = 0.01), a shorter mean hospitalization (1.4 vs. 3.0 days; P < 0.001), and a longer mean operative time (224.8 vs. 188.6 min; P < 0.001). No differences were noted among renal, infectious, or neurologic complications, although pulmonary complications were higher in the OSC group (0.3% vs. 1.0%; P = 0.08). No differences in 30-day mortality were noted (0.1% vs. 0.2%; P = 0.61).
MISC was associated with lower perioperative morbidity in this propensity-weighted analysis.
微创骶骨阴道固定术（MISC）已获得广泛认可，但缺乏随机或基于人群的数据支持其应用。本研究使用基于人群的数据比较了MISC和开放性骶骨阴道固定术（OSC）术后30天的结局。
利用国家外科质量改进计划（NSQIP）数据库获取2005年至2011年期间进行的1786例骶骨阴道固定术（659例OSC和1127例MISC）。对围手术期发病率进行倾向加权比较分析。
在接受骶骨阴道固定术的女性中，MISC手术的比例从2006年的7.1%增至2011年的68.8%。接受OSC的女性年龄更大（P<0.001），美国麻醉医师协会分级略高（P=0.11）。组间未经调整的比较显示，OSC组的表浅手术部位感染率（P<0.001）和深部手术部位感染率（P=0.009）更高。接受OSC的患者输血率也更高（P=0.02），住院时间更长（P<0.001），手术时间更短（P<0.001）。在倾向加权分析中，MISC与较低的伤口感染率（1.1%对3.0%；P=0.01）、较低的输血率（0.7%对2.3%；P=0.01）、较短的平均住院时间（1.4天对3.0天；P<0.001）以及较长的平均手术时间（224.8分钟对188.6分钟；P<0.001）相关。肾、感染或神经并发症方面未发现差异，尽管OSC组的肺部并发症更高（0.3%对1.0%；P=0.08）。30天死亡率无差异（0.1%对0.2%；P=0.61）。
在本倾向加权分析中，MISC与较低的围手术期发病率相关。
