Cleveland Clinic, Cleveland, OH, USA.
Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Int Urogynecol J. 2021 Aug;32(8):2135-2142. doi: 10.1007/s00192-021-04893-w. Epub 2021 Jul 2.
Women with hereditary disorders of connective tissue (HDCT) are at increased risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesized that patients would have increased incidence and severity of perioperative complications up to 6 weeks after surgeries for POP/SUI. Secondary objectives were to compare pre- and post-operative pelvic floor symptoms and anatomical support as well as pelvic floor disorder recurrence.
In this multi-center retrospective cohort study, we identified patients with HDCTs by patient history and ICD-9 codes over an 11-year period. Controls without HDCTs were matched 2:1 to the primary POP or SUI procedure and surgeon. Demographic characteristics, perioperative pelvic floor information and complications were collected. A sample size of 65 HDCT patients and 130 controls was calculated to detect a 20% difference in complications with 80% power and alpha of 0.05.
We identified 59 HDCT patients and 118 controls. Of the women with HDCTs, 49% had Ehlers-Danlos, 22% joint hypermobility syndrome, 15% Marfan syndrome, and 14% had others. Compared with controls, HDCT patients had more total perioperative complications (46% vs 22%, p = 0.002); an age-adjusted relative risk of complications was 1.4 (CI 0.7-2.6). HDCT patients had more Clavien-Dindo grades I and II complications (p = 0.02, 0.03) and more hospital readmissions (14% vs 3%, p = 0.01) than controls. There was no difference in the incidence of specific complications nor was there a difference in recurrence of POP (10%) or SUI (11%) between groups.
Patients with HDCTs had more Clavien-Dindo grade I and II complications following pelvic floor reconstructive surgery and more readmissions.
患有结缔组织遗传性疾病（HDCT）的女性患盆腔器官脱垂（POP）和压力性尿失禁（SUI）的风险增加。我们假设患者在 POP/SUI 手术后 6 周内围手术期并发症的发生率和严重程度会增加。次要目标是比较术前和术后盆底症状和解剖支持以及盆底障碍复发情况。
在这项多中心回顾性队列研究中，我们通过病史和 ICD-9 编码在 11 年期间确定了患有 HDCT 的患者。无 HDCT 的对照组按原发性 POP 或 SUI 手术和外科医生 2:1 匹配。收集人口统计学特征、围手术期盆底信息和并发症。计算了 65 例 HDCT 患者和 130 例对照的样本量，以检测并发症有 20%差异的 80%效力和 0.05 的α值。
我们确定了 59 例 HDCT 患者和 118 例对照。在患有 HDCT 的女性中，49%患有埃勒斯-当洛斯综合征，22%患有关节过度活动综合征，15%患有马凡综合征，14%患有其他疾病。与对照组相比，HDCT 患者的总围手术期并发症更多（46% vs 22%，p=0.002）；年龄调整后的并发症相对风险为 1.4（CI 0.7-2.6）。HDCT 患者的 Clavien-Dindo Ⅰ级和Ⅱ级并发症更多（p=0.02，0.03），住院再入院率更高（14% vs 3%，p=0.01）。两组之间特定并发症的发生率或 POP（10%）或 SUI（11%）的复发率没有差异。
患有 HDCT 的患者在接受盆底重建手术后出现更多的 Clavien-Dindo Ⅰ级和Ⅱ级并发症，且再入院率更高。
