Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Am J Obstet Gynecol. 2022 Aug;227(2):315.e1-315.e7. doi: 10.1016/j.ajog.2022.05.018. Epub 2022 May 11.
Symptomatic pelvic organ prolapse is common and affects 25% to 35% of women worldwide. As this growing patient need is being met by surgeons from diverse training backgrounds, it is important to both characterize the differences in surgeon practice patterns and examine postoperative outcomes to ensure optimal patient care.
To determine the association between surgeon specialty and postoperative outcomes following surgery for pelvic organ prolapse.
This was a retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program Gynecologic reconstructive surgery targeted database between 2014 and 2018. Pelvic organ prolapse surgeries were identified using Current Procedural Terminology codes, and surgical cases performed by urogynecologists or obstetrician-gynecologists were included for analysis. The primary outcome was any 30-day postoperative complication following prolapse surgery. The secondary outcomes were any major or minor postoperative complications, genitourinary complications, reoperation, or readmission within 30-days following surgery. Descriptive statistics were used to characterize the cohort, and pairwise analyses were used to describe the differences between the cases performed by the surgeon specialties. Multivariable logistic regression was used to control for potential confounders.
A total of 3358 women underwent prolapse surgery-68% performed by urogynecologists and 32% by obstetrician-gynecologists. The 30-day postoperative complication rate was higher for surgeries performed by obstetrician-gynecologists than for surgeries performed by urogynecologists (10.7% vs 7.0%, respectively; P<.001). There was no difference in the readmission rates between the 2 groups (2.1% vs 2.0%; P=1.000). However, the reoperation rates were higher for surgeries performed by obstetrician-gynecologists (1.8% vs 1.0%; P=.040). In a multivariable logistic regression model controlling for age, body mass index, American Society of Anesthesiology class, smoking, and type of concomitant surgery (hysterectomy, apical suspension, other prolapse surgery, obliterative procedure, or sling), prolapse surgery performed by a urogynecologist remained associated with nearly 40% lower odds of any 30-day postoperative complication (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80).
Prolapse surgery performed by a urogynecologist is associated with lower odds of any 30-day postoperative complication than that performed by an obstetrician-gynecologist.
有症状的盆腔器官脱垂很常见，影响全球 25%至 35%的女性。随着越来越多的患者需要接受手术治疗，而这些手术是由来自不同培训背景的外科医生进行的，因此，了解外科医生手术方式的差异并检查术后结果以确保患者获得最佳治疗至关重要。
确定外科医生专业与盆腔器官脱垂手术后结局之间的关系。
这是一项回顾性分析，使用美国外科医师学会国家外科质量改进计划妇科重建手术靶向数据库，时间范围为 2014 年至 2018 年。使用当前操作术语 (Current Procedural Terminology，CPT) 代码识别盆腔器官脱垂手术，纳入由妇科泌尿医生或妇产科医生进行的手术病例进行分析。主要结局是脱垂手术后 30 天内任何术后并发症。次要结局是任何主要或次要术后并发症、泌尿生殖系统并发症、手术后 30 天内再次手术或再次入院。使用描述性统计数据来描述队列特征，并使用两两分析来描述由不同外科医生专业进行的病例之间的差异。多变量逻辑回归用于控制潜在的混杂因素。
共有 3358 名女性接受了脱垂手术，其中 68%由妇科泌尿医生完成，32%由妇产科医生完成。妇产科医生进行的手术 30 天术后并发症发生率高于妇科泌尿医生（分别为 10.7%和 7.0%；P<.001）。两组患者的再入院率无差异（2.1%比 2.0%；P=1.000）。然而，妇产科医生进行的手术再手术率更高（1.8%比 1.0%；P=.040）。在多变量逻辑回归模型中，控制年龄、体重指数、美国麻醉医师协会分级、吸烟以及同时进行的手术类型（子宫切除术、顶端悬吊术、其他脱垂手术、闭塞术或吊带术）后，妇科泌尿医生进行的脱垂手术与 30 天内任何术后并发症的几率降低近 40%相关（调整后的优势比，0.62；95%置信区间，0.48-0.80）。
与妇产科医生相比，由妇科泌尿医生进行的脱垂手术与 30 天内任何术后并发症的几率较低相关。
