Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2018 Oct;200(4):862-867. doi: 10.1016/j.juro.2018.03.131. Epub 2018 Apr 7.
We evaluated the perioperative morbidity of open abdominal sacrocolpopexy and minimally invasive sacrocolpopexy using data on a contemporary nationwide cohort.
We used the ACS (American College of Surgeons) NSQIP® (National Surgical Quality Improvement Program) database to identify women who underwent abdominal or minimally invasive sacrocolpopexy from 2010 to 2016. Associations of surgical approach with 30-day complications, blood transfusion, prolonged hospitalization and reoperation were evaluated by logistic regression. Hospital readmission within 30 days was calculated by the person-years method and Cox proportional hazard models.
A total of 4,362 women underwent sacrocolpopexy, including abdominal sacrocolpopexy in 1,179 (27%) and minimally invasive sacrocolpopexy in 3,183 (73%). The proportion of minimally invasive sacrocolpopexy increased during the study period from 70% in 2010 to 82% in 2016. Baseline characteristics were similar between the treatment groups aside from a higher rate of chronic obstructive pulmonary disease (p = 0.03) and higher preoperative albumin (p <0.0001) among abdominal sacrocolpopexy cases. Compared to abdominal sacrocolpopexy, minimally invasive sacrocolpopexy was associated with lower rates of 30-day complications (p = 0.001), deep vein thrombosis/pulmonary embolism (p = 0.02), surgical site infections (p <0.0001), shorter hospitalization (p <0.0001) and fewer blood transfusions (p = 0.01). Minimally invasive sacrocolpopexy was also associated with a lower 30 person-days readmission rate (2% vs 2.7%, p ≤0.0001) and 30-day reoperation rate (1.1% vs 1.4%, p <0.0001). On multivariable analysis minimally invasive sacrocolpopexy was independently associated with a reduced risk of 30-day complications (OR 0.46, 95% CI 0.28, 0.76, p = 0.002), blood transfusion (OR 0.33, 95% CI 0.15, 0.74, p = 0.007), prolonged hospitalization (OR 0.16, 95% CI 0.12, 0.23, p <0.001) and readmission (HR 0.62, 95% CI 0.41, 0.96, p = 0.03).
Minimally invasive sacrocolpopexy was associated with reduced rates of 30-day complications, blood transfusion, prolonged hospitalization and hospital readmission compared to abdominal sacrocolpopexy.
我们利用当代全国队列的 ACS NSQIP®（美国外科医师学会国家外科质量改进计划）数据库，评估了开放式经腹和经微创途径进行骶骨阴道固定术的围手术期发病率。
我们使用 ACS NSQIP®（美国外科医师学会国家外科质量改进计划）数据库，确定了 2010 年至 2016 年间接受经腹或微创经骶骨阴道固定术的女性。通过逻辑回归评估手术途径与 30 天并发症、输血、住院时间延长和再次手术的相关性。通过人年法和 Cox 比例风险模型计算 30 天内的医院再入院率。
共 4362 名女性接受了骶骨阴道固定术，其中 1179 名（27%）接受了经腹骶骨阴道固定术，3183 名（73%）接受了经微创骶骨阴道固定术。研究期间，微创经骶骨阴道固定术的比例从 2010 年的 70%增加到 2016 年的 82%。治疗组之间的基线特征相似，但经腹骶骨阴道固定术的慢性阻塞性肺疾病发生率（p = 0.03）和术前白蛋白水平（p<0.0001）较高。与经腹骶骨阴道固定术相比，微创经骶骨阴道固定术与较低的 30 天并发症发生率（p = 0.001）、深静脉血栓/肺栓塞（p = 0.02）、手术部位感染（p<0.0001）、较短的住院时间（p<0.0001）和较少的输血（p = 0.01）相关。微创经骶骨阴道固定术与较低的 30 天再入院率（2%与 2.7%，p ≤0.0001）和 30 天再手术率（1.1%与 1.4%，p<0.0001）相关。多变量分析显示，微创经骶骨阴道固定术与 30 天并发症风险降低独立相关（OR 0.46，95%CI 0.28，0.76，p = 0.002）、输血风险降低（OR 0.33，95%CI 0.15，0.74，p = 0.007）、住院时间延长（OR 0.16，95%CI 0.12，0.23，p<0.001）和再入院风险降低（HR 0.62，95%CI 0.41，0.96，p = 0.03）。
与经腹骶骨阴道固定术相比，微创经骶骨阴道固定术与 30 天并发症、输血、住院时间延长和医院再入院率降低相关。
