Department of Obstetrics and Gynecology, The Ottawa Hospital.
Urogynecology (Phila). 2022 Dec 1;28(12):834-841. doi: 10.1097/SPV.0000000000001234. Epub 2022 Aug 11.
Apical suspension, including uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF), is the standard of care at vaginal hysterectomy. Although the equivalence of anatomic and clinical outcomes after USLS and SSLF is established, comparing surgical complications specific to patients undergoing concurrent vaginal hysterectomy further informs decision making regarding operative approach.
This study aims to compare complications in the first 30 days after surgery in patients undergoing USLS and SSLF at vaginal hysterectomy for pelvic organ prolapse.
This retrospective, population-based cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing USLS or SSLF at vaginal hysterectomy for pelvic organ prolapse between 2012 and 2019. The primary outcome was a composite of surgical complications excluding urinary tract infection (UTI). Odds of the primary outcome, readmission, reoperation, and UTI were evaluated by multivariable logistic regression models.
Of 10,210 eligible patients, 7,127 patients underwent USLS and 3,083 patients underwent SSLF. Uterosacral ligament suspension was associated with a 25% lower odds of the composite complication outcome that excluded UTI compared with SSLF (adjusted odds ratio, 0.75; 95% confidence interval, 0.63-0.90). Urinary tract infection was the most common complication and occurred more commonly in patients undergoing USLS (6.5% vs 4.9%; adjusted odds ratio, 1.29; 95% confidence interval, 1.06-1.56). There was no significant difference in Clavien-Dindo class IV complications, readmission, or reoperation between approaches.
Uterosacral ligament suspension was associated with a lower odds of complications excluding UTI compared with SSLF. Urinary tract infection was more common among patients having USLS. The odds of serious complications, readmission, and reoperation were low and comparable between groups.
在阴道子宫切除术时，顶端悬吊术，包括子宫骶骨韧带悬吊术（USLS）和骶骨棘韧带固定术（SSLF），是护理标准。虽然 USLS 和 SSLF 后的解剖和临床结果等同已经确立，但比较行阴道子宫切除术的患者中特定于手术的并发症可以进一步为手术方法的决策提供信息。
本研究旨在比较因盆腔器官脱垂而行阴道子宫切除术时行 USLS 和 SSLF 的患者术后 30 天内的手术并发症。
这项回顾性基于人群的队列研究使用美国外科医师学会国家手术质量改进计划数据库，确定 2012 年至 2019 年间因盆腔器官脱垂而行 USLS 或 SSLF 的阴道子宫切除术患者。主要结局是排除尿路感染（UTI）的手术并发症综合指标。通过多变量逻辑回归模型评估主要结局、再入院、再次手术和 UTI 的可能性。
在 10210 名合格患者中，7127 名患者行 USLS，3083 名患者行 SSLF。与 SSLF 相比，USLS 发生排除 UTI 的复合并发症的可能性降低 25%（调整后的优势比，0.75；95%置信区间，0.63-0.90）。尿路感染是最常见的并发症，且在 USLS 组中更为常见（6.5% vs. 4.9%；调整后的优势比，1.29；95%置信区间，1.06-1.56）。两种方法之间在四级 Clavien-Dindo 并发症、再入院或再次手术方面没有显著差异。
与 SSLF 相比，USLS 发生排除 UTI 的并发症的可能性较低。USLS 患者中 UTI 更为常见。严重并发症、再入院和再次手术的可能性较低，且两组之间相似。
