Bochenska Katarzyna, Leader-Cramer Alix, Mueller Margaret, Davé Bhumy, Alverdy Alexandria, Kenton Kimberly
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Prentice Women's Hospital, 250 E Superior Street, 05-2370, Chicago, IL, 60611, USA.
Int Urogynecol J. 2017 Nov;28(11):1671-1675. doi: 10.1007/s00192-017-3340-5. Epub 2017 May 3.
Pelvic organ prolapse is common in the elderly population and may be surgically treated with colpocleisis. We aimed to identify and compare surgical characteristics and 30-day perioperative complications in patients who underwent colpocleisis with and without concomitant vaginal hysterectomy (VH) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
Women who underwent vaginal closure procedures from 2006 to 2014 were identified utilizing Current Procedural Terminology (CPT) codes for LeFort colpocleisis (57120) and vaginectomy (57110). Patients undergoing a concomitant VH were identified by CPT codes ranging from 58260 to 58294. Variables including patient demographics, operative time, hospital length of stay, transfusion' and reoperation were evaluated. Specific medical complications, surgical site infection' and urinary tract infection (UTI) rates were calculated. Variables were analyzed using chi-squared, Fisher's exact, student's t tests and logistic regression.
We identified 1,027 women in the ACS-NSQIP database who underwent vaginal closure procedures. The majority of patients (893, 87.0%) underwent colpocleisis alone, and the remainder (134, 13.0%) underwent concomitant VH. Operative times were shorter in patients undergoing colpocleisis alone. UTI was the most common postoperative complication affecting 4.3% of the entire cohort. Twelve women (1.2%) had a serious medical complication, seven who underwent colpocleisis alone and five who underwent colpocleisis with concomitant VH. In backward logistic regression' serious medical complications were the only variable independently associated with VH at the time of colpocleisis (p < 0.05).
Colpocleisis is a safe procedure with rare serious adverse events.
盆腔器官脱垂在老年人群中很常见，可通过阴道封闭术进行手术治疗。我们旨在利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，识别并比较接受或未接受同期阴道子宫切除术（VH）的阴道封闭术患者的手术特征和30天围手术期并发症。
利用当前手术操作术语（CPT）代码识别2006年至2014年接受阴道封闭手术的女性，代码为勒福特阴道封闭术（57120）和阴道切除术（57110）。通过CPT代码范围为58260至58294识别接受同期VH的患者。评估包括患者人口统计学、手术时间、住院时间、输血和再次手术等变量。计算特定的医疗并发症、手术部位感染和尿路感染（UTI）发生率。使用卡方检验、费舍尔精确检验、学生t检验和逻辑回归分析变量。
我们在ACS-NSQIP数据库中识别出1027名接受阴道封闭手术的女性。大多数患者（893名，87.0%）仅接受阴道封闭术，其余患者（134名，13.0%）接受同期VH。仅接受阴道封闭术的患者手术时间较短。UTI是最常见的术后并发症，影响了整个队列的4.3%。12名女性（1.2%）出现严重医疗并发症，其中7名仅接受阴道封闭术，5名接受阴道封闭术并同期VH。在向后逻辑回归中，严重医疗并发症是阴道封闭术时与VH独立相关的唯一变量（p < 0.05）。
阴道封闭术是一种安全的手术，严重不良事件罕见。
