Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44108, USA.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
World J Urol. 2021 Jun;39(6):2191-2196. doi: 10.1007/s00345-020-03360-3. Epub 2020 Jul 15.
To determine if graft augmentation with anterior colporrhaphy (AC+G) is associated with higher complication rates compared to native tissue repair (AC).
Retrospective cohort study using data from the ACS-NSQIP database between 2010 and 2017. CPT codes were used to identify women undergoing AC+G and AC. Propensity scores for the likelihood of undergoing AC+G were calculated and were used to match to women undergoing native tissue repair at a ratio of 1:2. The primary outcome was the composite complication rate. Descriptive statistics are reported as means with standard deviations for parametric data and as medians and interquartile ranges for non-parametric data. Pairwise comparisons were performed using Fisher's exact test, Wilcoxon rank-sum and Student's t test as appropriate. Multivariable logistic regression was then used to adjust for confounders to identify statistically significant factors associated with the likelihood of experiencing a complication after prolapse repair.
582 women met inclusion criteria for AC+G and were matched with 1164 women undergoing AC. There were no differences in preoperative characteristics between groups. There was no difference in the composite complication rate, (10.8% vs. 8.5%, p = 0.13) between groups. Dependent functional status (aOR 4.31, 95% CI 1.96-13.58) was the strongest predictor of the likelihood of a complication: other significant predictors were operating time greater than 20 min (aOR 1.68, 95% CI 1.19-2.38) and ASA class greater than 2 (aOR 1.44, 95% CI 1.01-2.05).
There is no increase in 30-day complication rates in women undergoing AC+G compared to a matched cohort of those undergoing AC alone.
确定与使用自体组织修复（AC）相比，在前阴道壁修补术（AC+G）中进行移植物增强是否与更高的并发症发生率相关。
使用 2010 年至 2017 年 ACS-NSQIP 数据库中的数据进行回顾性队列研究。使用 CPT 代码识别接受 AC+G 和 AC 的女性。计算进行 AC+G 的可能性的倾向评分，并以 1:2 的比例与接受自体组织修复的女性相匹配。主要结果是复合并发症发生率。描述性统计数据以参数数据的平均值和标准差以及非参数数据的中位数和四分位距报告。使用 Fisher 精确检验、Wilcoxon 秩和检验和学生 t 检验进行两两比较，视情况而定。然后使用多变量逻辑回归来调整混杂因素，以确定与脱垂修复后发生并发症的可能性相关的统计学显著因素。
582 名女性符合 AC+G 的纳入标准，并与 1164 名接受 AC 的女性相匹配。两组患者的术前特征无差异。两组之间的复合并发症发生率无差异（10.8%对 8.5%，p=0.13）。依赖功能状态（比值比 4.31，95%置信区间 1.96-13.58）是并发症发生可能性的最强预测因素：其他显著预测因素包括手术时间超过 20 分钟（比值比 1.68，95%置信区间 1.19-2.38）和 ASA 分级大于 2（比值比 1.44，95%置信区间 1.01-2.05）。
与单独接受 AC 的匹配队列相比，在接受 AC+G 的女性中，30 天并发症发生率没有增加。
