From the Division of Urogynecology, Mayo Clinic.
Surgical Outcomes Program, Mayo Clinic Kern Center for the Science of Health Care Delivery.
Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):72-77. doi: 10.1097/SPV.0000000000000738.
The objective of this study was to evaluate perioperative complications in women who underwent minimally invasive sacrocolpopexy (MISC) versus mesh-augmented vaginal repair (vaginal mesh) for pelvic organ prolapse.
We identified patients undergoing MISC and vaginal mesh via Current Procedural Terminology codes from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2016. Those undergoing concomitant hysterectomy were excluded. Univariate analyses were performed to compare baseline characteristics and 30-day complications. Multivariable logistic regression models were constructed to assess the association between surgical approach and complications, prolonged hospitalization, reoperation, and blood transfusion. A multivariable Cox proportional hazard model was used to evaluate hospital readmission.
A total of 5722 patients were identified (2573 MISC [45%], 3149 vaginal mesh [55%]). Those undergoing MISC repairs had a significantly lower rate of urinary tract infection (3.1 vs 4.2%; P = 0.03) and blood transfusion (0.5 vs 1.4%; P < 0.001). There was no difference in reoperation rate (1.3 vs 1.6%; P = 0.35). Multivariable analysis showed no significant association of MISC with overall (odds ratio [OR], 0.91; P = 0.44), major (OR, 1.30; P = 0.31), or minor complication (OR, 0.85; P = 0.26). There were lower odds of receiving a blood transfusion (OR, 0.44; P = 0.02) and higher odds of prolonged hospitalization (>2 days; OR, 1.47; P = 0.003) for the MISC group. There was no difference in reoperation (OR, 0.79; P = 0.38) or hospital readmissions (hazard ratio, 1.25, P = 0.32).
Minimally invasive sacrocolpopexy was associated with a lower rate of blood transfusion than transvaginal mesh placement. There was no significant difference in 30-day complication rates, reoperation, or readmission between these prolapse procedures when performed without concomitant hysterectomy.
本研究旨在评估接受微创骶骨阴道固定术（MISC）与经阴道网片修补术（阴道网片）治疗盆腔器官脱垂的患者围手术期并发症。
我们通过美国外科医师学院国家手术质量改进计划数据库中的当前操作术语代码确定了 2005 年至 2016 年期间接受 MISC 和阴道网片的患者。排除同时行子宫切除术的患者。进行单变量分析以比较基线特征和 30 天并发症。构建多变量逻辑回归模型评估手术方式与并发症、住院时间延长、再次手术和输血之间的关系。多变量 Cox 比例风险模型用于评估医院再入院。
共确定了 5722 例患者（MISC 修复 2573 例[45%]，阴道网片修复 3149 例[55%]）。接受 MISC 修复的患者尿路感染（3.1% vs. 4.2%；P=0.03）和输血（0.5% vs. 1.4%；P<0.001）的发生率显著较低。再次手术率无差异（1.3% vs. 1.6%；P=0.35）。多变量分析显示，MISC 与总并发症（比值比[OR]，0.91；P=0.44）、主要并发症（OR，1.30；P=0.31）或轻微并发症（OR，0.85；P=0.26）均无显著相关性。MISC 组接受输血的可能性较低（OR，0.44；P=0.02），住院时间延长（>2 天；OR，1.47；P=0.003）的可能性较高。再次手术无差异（OR，0.79；P=0.38）或医院再入院率（危险比，1.25，P=0.32）。
与经阴道网片放置相比，微创骶骨阴道固定术输血率较低。在不伴子宫切除术的情况下，这些脱垂手术之间 30 天并发症发生率、再次手术或再入院率无显著差异。
