Background

Minimally invasive pelvic reconstructive surgery is becoming increasingly common; however, data on readmission and emergency department visits within 30 days of surgery are limited.

Objective

Our objective was to report the risk factors for 30-day readmission and emergency department visits after minimally invasive pelvic organ prolapse surgery.

Study Design

This retrospective cohort study included all minimally invasive urogynecologic prolapse procedures with and without concomitant hysterectomy performed within a large managed healthcare organization of 4.5 million members from 2008 to 2018. We queried the system-wide medical record for current procedural terminology and International Classification of Diseases, Ninth or Tenth Revision codes for all included procedures and patient demographic and perioperative data. Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department visits. Risk factors including demographics, surgical approach, and characteristics for 30-day outcomes were examined using odds ratios and chi-square tests for categorical variables and Wilcoxon rank sum tests for continuous variables.

Results

Of the 13,445 patients undergoing prolapse surgery, 6171 patients underwent concomitant hysterectomy whereas 7274 did not. Readmission within 30 days was 2.1% for those with and 1.5% for those without a concomitant hysterectomy. Emergency department visit within 30 days was 9.5% in those with and 9.2% in those without a concomitant hysterectomy. Concomitant hysterectomy (adjusted odds ratio, 1.41; 95% confidence interval, 1.07–1.81) was associated with an increased risk of 30-day readmission. There was no difference in risk of 30-day readmission when comparing the various approaches to hysterectomy. When compared with patients who underwent sacrocolpopexy, undergoing a sacrospinous ligament suspension increased the risk (adjusted odds ratio, 2.43; 95% confidence interval, 1.22–4.70) of 30-day readmission, while undergoing uterosacral ligament suspension (adjusted odds ratio, 0.99; 95% confidence interval, 0.57–1.63) or colpocleisis (adjusted odds ratio, 1.79; 95% confidence interval, 0.50–5.24) did not in the concomitant hysterectomy subgroup, when compared with patients who underwent sacrocolpopexy, there was no difference in the risk of 30-day readmission for sacrospinous ligament suspension (adjusted odds ratio, 1.09; 95% confidence interval, 0.61–3.34), uterosacral ligament suspension (adjusted odds ratio, 1.39; 95% confidence interval, 0.61–3.34) or colpocleisis (adjusted odds ratio, 1.88; 95% confidence interval, 0.71–4.02). Similarly, sacrocolpopexy was not associated with an increased risk of emergency department visits in either subgroup. For those who had a concomitant hysterectomy, the patient factors that were associated with an increased 30-day readmission risk were hypertension (odds ratio, 1.54; 95% confidence interval, 1.03–2.31; P=.03) and chronic obstructive pulmonary disease (odds ratio, 2.52; 95% confidence interval, 1.32–4.81; P<.01). For those whose prolapse procedure did not include concomitant hysterectomy, the patient factors that were associated with an increased 30-day readmission risk were age (odds ratio, 1.05; 95% confidence interval, 1.02–1.07; P<.01) and heart failure (odds ratio, 3.26; 95% confidence interval, 1.68–6.33; P<.01).

Conclusion

In women undergoing minimally invasive pelvic organ prolapse surgery, sacrocolpopexy was not associated with an increased risk of 30-day readmission and emergency department visits. Clinicians may consider surgical approach and other factors when counseling patients about their risks after minimally invasive pelvic organ prolapse surgery.

中文翻译：

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微创骶骨阴道固定术和阴道顶端盆腔器官脱垂手术后的再入院和急诊就诊

背景

微创骨盆重建手术正变得越来越普遍；然而，手术后 30 天内再入院和急诊就诊的数据有限。

客观的

我们的目标是报告微创盆腔器官脱垂手术后 30 天再入院和急诊就诊的风险因素。

学习规划

这项回顾性队列研究包括 2008 年至 2018 年在一个拥有 450 万成员的大型管理式医疗保健组织内进行的所有微创泌尿妇科脱垂手术，并伴有或不伴有子宫切除术。所有包含的程序和患者人口统计学和围手术期数据的第九或第十次修订代码。我们的主要结果是 30 天再入院，次要结果是 30 天急诊就诊。风险因素包括人口统计学、手术方法和 30 天结果的特征，使用优势比和卡方检验对分类变量进行检验，对连续变量使用 Wilcoxon 秩和检验。

结果

在接受脱垂手术的 13445 名患者中，6171 名患者同时接受了子宫切除术，而 7274 名没有。30 天内再次入院的患者为 2.1%，未同时进行子宫切除术的患者为 1.5%。30 天内的急诊就诊率在有子宫切除术的患者中为 9.5%，在未进行子宫切除术的患者中为 9.2%。伴随子宫切除术（调整后的比值比，1.41；95% 置信区间，1.07-1.81）与 30 天再入院的风险增加相关。比较各种子宫切除术的方法时，30 天再入院的风险没有差异。与接受骶骨阴道固定术的患者相比，接受骶棘韧带悬吊术增加了 30 天再入院的风险（调整后的优势比，2.43；95% 置信区间，1.22-4.70），接受子宫骶韧带悬吊术（调整后的优势比，0.99；95% 置信区间，0.57-1.63）或阴道闭锁（调整后的优势比，1.79；95% 置信区间，0.50-5.24）时，与子宫切除术亚组相比没有在接受骶骨阴道固定术的患者中，骶棘韧带悬吊术（调整后的比值比，1.09；95% 置信区间，0.61-3.34）和子宫骶韧带悬吊术（调整后的比值比，1.39；95%）在 30 天再入院的风险上没有差异置信区间，0.61–3.34）或阴道闭锁（调整后的优势比，1.88；95% 置信区间，0.71–4.02）。同样，骶骨阴道固定术与任一亚组的急诊就诊风险增加无关。对于那些同时进行子宫切除术的人，P = .03）和慢性阻塞性肺疾病（优势比，2.52；95% 置信区间，1.32–4.81；P <.01）。对于那些脱垂手术不包括伴随子宫切除术的患者，与 30 天再入院风险增加相关的患者因素是年龄（优势比，1.05；95% 置信区间，1.02-1.07；P <.01）和心力衰竭（优势比，3.26；95% 置信区间，1.68–6.33；P <.01）。

结论

在接受微创盆腔器官脱垂手术的女性中，骶骨阴道固定术与 30 天再入院和急诊就诊的风险增加无关。在向患者咨询微创盆腔器官脱垂手术后的风险时，临床医生可能会考虑手术方法和其他因素。