Risk Factors for 30-Day Perioperative Complications after Le Fort Colpocleisis

Catanzarite, Tatiana; Rambachan, Aksharananda; Mueller, Margaret; Pilecki, Matthew; Kim, John Y.S.; Kenton, Kimberly

doi:10.1016/j.juro.2014.03.040

Cited by 32 publications

(22 citation statements)

References 15 publications

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“…Zebede et al reported complication and mortality rates of 15.2% and 1.3%, respectively [15]. Catanzarite et al reported complications in 8.1% of 283 women who underwent Le Fort colpocleisis [16]. As in the current study, the most common complication was urinary tract infection, which was reported in 18 women (6.4%).…”

Section: Discussionsupporting

confidence: 59%

Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women

Krissi

Aviram

Eitan

et al. 2015

International Journal of Surgery

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Section: Discussionsupporting

confidence: 59%

Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women

Krissi

Aviram

Eitan

et al. 2015

International Journal of Surgery

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“…8 In another study, objective and subjective cure rates following colpocleisis in women over the age of 80 have been shown to be similar to those among younger women, 17 further promoting their safety and benefit in the older female population.…”

Section: Discussionmentioning

confidence: 91%

“…The advantages of the obliterative approach include the option for local anesthesia, shorter operative times, lower blood loss and faster recovery. 8 These benefits, in combination with extremely high success rates upwards of 90%, 9–12 makes this procedure ideally suited for frail older individuals who are not sexually active. The real-world use and outcomes of this obliterative procedure in comparison to the other reconstructive procedures, however, has yet to be explored.…”

Section: Introductionmentioning

confidence: 99%

Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study

et al. 2017

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Purpose To determine whether frailty affects the type of pelvic organ prolapse (POP) surgery performed and the odds of postoperative complications. Materials and Methods This is a retrospective cohort study of women undergoing obliterative and reconstructive surgery for POP in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2005 to 2013. We quantified frailty using the NSQIP Frailty Index (NSQIP-FI) and used logistic regression models predicting type of procedure (colpocleisis) and odds of post-operative complications. Results We identified a total of 12,731 women undergoing POP repairs, 5.3% of which were colpocleisis procedures, from 2005–2013. Among women undergoing colpocleisis, the average age was 79.2 years and 28.5% had a NSQIP-FI of 0.18 or higher, indicating frailty. Women undergoing colpocleisis procedures had higher odds of being frail (OR 1.9 95% CI 1.4–2.6 for NSQIP-FI 0.18 compared to NSQIP-FI 0) and were older aged (OR 486.4 95% CI 274.6–861.7 for age 85+ compared to <65). For all types of POP procedures, frailty increased the odds of complications (OR 2.8 95% CI 1.8–3.0 for NSQIP-FI 0.18 compared to NSQIP-FI 0), after adjusting for age and type of POP procedure. Conclusions For POP surgery, age is more strongly associated with type of procedure performed than frailty, however, frailty is more strongly associated with postoperative complications than age. Furthermore, incorporating frailty into preoperative decision-making is important for improving expectations and outcomes among older women considering POP surgery.

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“…However, our findings are consistent with other studies that have shown that COPD in general is a risk factor for perioperative morbidity after urogynecologic and nonurogynecolgic surgery. For example, in a study published by Catanzarite et al, 15 COPD was significantly associated with 30-day perioperative complications in patients who underwent LeFort colpocleisis. Similarly, COPD was shown to increase the length of hospital stay in coronary artery bypass graft surgery patients 16 and was also found to be the only preoperative comorbid medical condition that increased the risk of readmission in a large cohort of patients who underwent outpatient thyroidectomy.…”

Section: Commentmentioning

confidence: 96%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE:We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN:This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS:In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2e38.6), which included 20.3% (95% CI, 17.9e23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6e1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4e6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6e3.5) and 0.8% (95% CI, 0.4e1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02e0.6) and 0.8% (95% CI, 0.4e1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4e16.8): 10.6% (95% CI, 8.8e12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2e13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4e4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION:Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse. P elvic organ prolapse (POP) is a common problem in women and is associated with considerable morbidity and a decreased quality of life. In the United States, the prevalence of POP is approximately 2.9% 1 and nearly 300,000 women undergo surgery annually for prolapse. 2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterec...

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Risk Factors for 30-Day Perioperative Complications after Le Fort Colpocleisis

Abstract: Mortality and complication rates after colpocleisis are low with urinary tract infection being the most common postoperative complication. Concomitant sling placement does not increase 30-day complication rates.

Cited by 32 publications

References 15 publications

Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women

Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women

Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

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