Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center and Georgetown University, Washington, DC.
From the Division of Urogynecology and Reconstructive Pelvic Surgery.
Urogynecology (Phila). 2022 Aug 1;28(8):539-546. doi: 10.1097/SPV.0000000000001205. Epub 2022 Jun 18.
Data on the correlation between length of stay and postoperative complications following urogynecologic surgery are limited.
The objective of this study was to use a nationwide database to examine the correlation between length of stay and 30-day postoperative complications following minimally invasive apical prolapse repair.
This retrospective cohort study included women in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2018 who underwent laparoscopic/robotic sacrocolpopexy or uterosacral/sacrospinous repair and were discharged on postoperative day 0 (POD0) or 1 (POD1). The primary outcome was 30-day postoperative complication rate.
Of the 28,269 women discharged home on POD0/1, 12,663 (45%) underwent laparoscopic/robotic sacrocolpopexy, and 15,606 (55%) underwent uterosacral/sacrospinous repair. Women discharged on POD0 were less likely to be White, less likely to have diabetes or hypertension, had lower mean body mass index, and were less likely to have undergone a hysterectomy ( P < 0.05 for all). Within 30 days of surgery, 7% had a postoperative complication, and 3% had a major complication. Women discharged on POD0 had a lower risk of any complication or any major complication. The most common complication, urinary tract infection, was lower in women discharged on POD0 (3% vs 4%, P < 0.01). Women discharged home on the same day had a higher risk of superficial surgical site infection after undergoing laparoscopic/robotic sacrocolpopexy (1.3% vs 0.5%, P < 0.01) and a higher risk of myocardial infarction/cardiac arrest after uterosacral/sacrospinous repair (0.2% vs 0%, P < 0.04).
In women undergoing minimally invasive reconstructive apical repair, discharge on POD0 is correlated with similar or better (lower) 30-day postoperative complication rates compared with women discharged on POD1.
关于尿妇科手术后住院时间与术后并发症之间相关性的数据有限。
本研究旨在利用全国性数据库，检查微创 apical prolapse 修复术后住院时间与 30 天术后并发症之间的相关性。
这是一项回顾性队列研究，纳入了 2008 年至 2018 年期间在美国外科医师学院国家手术质量改进计划数据库中接受腹腔镜/机器人 sacrocolpopexy 或 uterosacral/sacrospinous 修复术并在术后第 0 天（POD0）或第 1 天（POD1）出院的女性。主要结局为 30 天术后并发症发生率。
在出院于 POD0/1 的 28269 名女性中，12663 名（45%）行腹腔镜/机器人 sacrocolpopexy，15606 名（55%）行 uterosacral/sacrospinous 修复术。出院于 POD0 的女性更不可能是白人，更不可能患有糖尿病或高血压，平均体重指数更低，且更不可能接受子宫切除术（所有 P<0.05）。术后 30 天内，7%的患者发生术后并发症，3%的患者发生重大并发症。出院于 POD0 的女性发生任何并发症或任何重大并发症的风险较低。最常见的并发症是尿路感染，出院于 POD0 的女性发生率较低（3%比 4%，P<0.01）。出院于同一天的女性行腹腔镜/机器人 sacrocolpopexy 后发生浅表手术部位感染的风险较高（1.3%比 0.5%，P<0.01），行 uterosacral/sacrospinous 修复术后发生心肌梗死/心搏骤停的风险较高（0.2%比 0%，P<0.04）。
在接受微创重建 apical 修复的女性中，与出院于 POD1 的女性相比，POD0 出院与相似或更低（较低）的 30 天术后并发症发生率相关。
