Surgery for pelvic organ prolapse tied to long-term reoperation risk for older women
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Key takeaways:
- Reoperation rate with surgical approaches was low but increased over time.
- Over 7 years, colpocleisis had the lowest reoperation likelihood for recurrence and the lowest reoperation likelihood for complications.
Different surgical approaches to apical pelvic organ prolapse were significantly associated with different long-term risks for reoperation among women aged 65 years or older, according to study results published in Obstetrics & Gynecology.
“When considering the approach to repair of pelvic organ prolapse, patients and their surgeons should consider long-term risks of reoperation,” Alexander Arkin Berger, MD, MPH, physician at Penn Medicine, told Healio. “Colpocleisis offers the lowest likelihood of reoperation for recurrence of prolapse followed by sacrocolpopexy, while colpocleisis followed by uterosacral ligament suspension has the lowest risk of reoperation for complications.”
Berger and colleagues conducted a nationwide, retrospective cohort study with data from 4,089 women aged 65 years and older with apical pelvic organ prolapse from the CMS 5% Limited Data Set. All women underwent sacrocolpopexy (n = 1,034), uterosacral ligament suspension (n = 717), sacrospinous ligament fixation (n = 1,529) or colpocleisis (n = 809) from 2011 to 2018.
The primary outcome was overall reoperation rate. Secondary outcomes included reoperation for pelvic organ prolapse and for complications.
Overall, reoperation rates were low, but increased over time. During a 7-year period, the overall reoperation rates were 7.3% for women who underwent colpocleisis, 10.4% for uterosacral ligament suspension, 12.5% for sacrocolpopexy and 15% for sacrospinous ligament fixation.
Reoperation rates for recurrent pelvic organ prolapse over 7 years was 2.9% for colpocleisis, 7.3% for sacrocolpopexy, 7.7% for uterosacral ligament suspension and 9.9% for sacrospinous ligament fixation. For complications, reoperation rates over 7 years were 5.3% for colpocleisis, 8.2% for sacrocolpopexy, 6.4% for uterosacral ligament suspension and 8.2% for sacrospinous ligament fixation.
“This study will help patients and their surgeons understand the long-term risk of reoperation after prolapse surgery. It helps compare the four common approaches to surgery with long-term follow-up data,” Berger said. “Additional long-term studies with diverse patient populations are needed.”
For more information:
Alexander Arkin Berger, MD, MPH, can be reached at alexanderbergermd@gmail.com