Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville Health, 4331 Churchman Avenue, Louisville, KY, 40215, USA.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA.
Int Urogynecol J. 2023 Sep;34(9):2061-2065. doi: 10.1007/s00192-023-05503-7. Epub 2023 Mar 15.
To identify the incidence and risk factors of gastrointestinal injury (GITI) related to pelvic organ prolapse (POP) surgery.
Women who underwent POP surgery between 2000 and 2020 were identified in the Premier Healthcare Database. The primary outcome was GITI, defined as small or large bowel injury or repair, and fistula or fistula repair. Differences between patients with and without GITI were evaluated, and a multivariable regression was performed to determine independent predictors of GITI.
We identified 563,661 index POP surgeries in female patients aged 18 years and older. Of these, 4582 (0.8%) had a bowel injury code within 1 year of index POP surgery. Patients who experienced GITI were more likely to be younger (49.9 ± 12.8 vs 50.9 ± 13.7), and receive surgery with a surgeon who performed less than 12 surgeries per year (48% vs 42%). Most GITI was diagnosed in the same month (73.4%) and same hospital encounter (54%) as index POP surgery. After adjusting for confounders, lysis of adhesions (aOR = 2.03, 95% CI: 1.48-2.72) and perioperative hematoma/hemorrhage (aOR = 2.87, 95%C I: 1.70-4.59) were strongly associated with GITI, while having surgery with a surgeon performing > 50 POP surgeries per year (aOR = 0.66, 95%C I: 0.59-0.75 and concomitant obliterative procedures (aOR = 0.48, 95% CI: 0.34-0.65) were associated with a lower probability of GITI.
The rate of GITI after POP surgery is less than 1%, and injuries are commonly diagnosed and treated in the same month as index surgery. High-volume surgeons and obliterative procedures may be protective against GITI.
确定与盆腔器官脱垂（POP）手术相关的胃肠道损伤（GITI）的发生率和危险因素。
在 Premier Healthcare Database 中确定了 2000 年至 2020 年间接受 POP 手术的女性患者。主要结局是 GITI，定义为小肠或大肠损伤或修复、瘘或瘘修复。评估了有和没有 GITI 的患者之间的差异，并进行了多变量回归以确定 GITI 的独立预测因素。
我们确定了 563661 例年龄在 18 岁及以上的女性患者的指数 POP 手术。其中，4582 例（0.8%）在指数 POP 手术后 1 年内有肠损伤代码。发生 GITI 的患者更年轻（49.9±12.8 岁 vs 50.9±13.7 岁），并且接受手术的医生每年进行的手术少于 12 次（48% vs 42%）。大多数 GITI 在与指数 POP 手术相同的月份（73.4%）和相同的医院就诊中（54%）诊断。在调整混杂因素后，粘连松解（OR=2.03，95%CI：1.48-2.72）和围手术期血肿/出血（OR=2.87，95%CI：1.70-4.59）与 GITI 密切相关，而手术医生每年进行超过 50 次 POP 手术（OR=0.66，95%CI：0.59-0.75）和同时进行闭塞性手术（OR=0.48，95%CI：0.34-0.65）与 GITI 的可能性较低相关。
POP 手术后 GITI 的发生率低于 1%，损伤通常在与指数手术相同的月份诊断和治疗。高容量外科医生和闭塞性手术可能对 GITI 具有保护作用。
