Linder Brian J, Gershman Boris, Bews Katherine A, Glasgow Amy E, Occhino John A
From the Departments of Urology.
Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
Female Pelvic Med Reconstr Surg. 2019 Sep/Oct;25(5):342-346. doi: 10.1097/SPV.0000000000000678.
The aim of this study was to compare the perioperative morbidity of minimally invasive sacrocolpopexy (MISC) and nonmesh apical vaginal surgeries for repair of vaginal vault prolapse using data from a contemporary nationwide cohort.
The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify women who underwent apical prolapse surgery via vaginal approach or MISC from 2010 to 2016. Those undergoing concomitant hysterectomy or transvaginal mesh placement were excluded. Associations of surgical approach with 30-day complications, prolonged hospitalization, and reoperation were evaluated using logistic regression. Readmission within 30 days was calculated using the person-years method and Cox proportional hazards models.
Overall, 6390 women underwent surgery, including 3852 (60%) via vaginal approach and 2538 (40%) via MISC. Patients undergoing MISC were younger (P < 0.0001) and less likely to have hypertension (P = 0.04) or chronic obstructive pulmonary disease (P = 0.008), with lower American Society of Anesthesiologists scores (P < 0.0001) and higher preoperative hematocrit (P = 0.009). The MISC cohort had a lower unadjusted rates of minor complications (3.9% vs 5.6%; P = 0.004), urinary tract infection (3.3% vs 4.8%; P = 0.004), and prolonged hospitalization (5.2% vs 7.9%; P < 0.0001), with a higher rate of nephrologic (P = 0.01) complications. On multivariable analysis, there were no significant associations of MISC with the risk of 30-day complications (odds ratio [OR], 1.51; 95% confidence interval [CI], 0.92-2.51; P = 0.11), prolonged hospitalization (OR, 0.96; 95% CI, 0.76-1.21; P = 0.72), readmission (HR 1.03; 95% CI, 0.71-1.49;P = 0.88), or reoperation (OR, 0.95; 95% CI, 0.57-1.60; P = 0.86).
Minimally invasive sacrocolpopexy is associated with similar rates of 30-day complications, prolonged hospitalization, readmission, and reoperation compared with nonmesh vaginal surgeries for apical prolapse.
本研究旨在利用当代全国队列的数据，比较微创骶骨阴道固定术（MISC）和非网片顶端阴道手术修复阴道穹窿脱垂的围手术期发病率。
使用美国外科医师学会国家外科质量改进计划数据库，识别2010年至2016年期间通过阴道途径或MISC进行顶端脱垂手术的女性。排除同时进行子宫切除术或经阴道放置网片的患者。使用逻辑回归评估手术方式与30天并发症、延长住院时间和再次手术之间的关联。采用人年法和Cox比例风险模型计算30天内再入院率。
总体而言，6390名女性接受了手术，其中3852名（60%）通过阴道途径，2538名（40%）通过MISC。接受MISC的患者更年轻（P<0.0001），患高血压（P=0.04）或慢性阻塞性肺疾病（P=0.008）的可能性更小，美国麻醉医师协会评分更低（P<0.0001），术前血细胞比容更高（P=0.009）。MISC队列的轻微并发症（3.9%对5.6%；P=0.004）、尿路感染（3.3%对4.8%；P=0.004）和延长住院时间（5.2%对7.9%；P<0.0001）的未调整发生率较低，肾病并发症发生率较高（P=0.01）。在多变量分析中，MISC与30天并发症风险（比值比[OR]，1.51；95%置信区间[CI]，0.92-2.51；P=0.11）、延长住院时间（OR，0.96；95%CI，0.76-1.21；P=0.72）、再入院（风险比1.03；95%CI，0.71-1.49；P=0.88）或再次手术（OR，0.95；95%CI，0.57-1.60；P=0.86）之间无显著关联。
与非网片阴道顶端脱垂手术相比，微创骶骨阴道固定术的30天并发症、延长住院时间、再入院和再次手术发生率相似。
