Trends in patient characteristics, surgical techniques, and associated complications over time in pelvic organ prolapse repair.

Abstract

<h4>Objective</h4>To investigate trends in pelvic organ prolapse (POP) surgical repair procedures and patient characteristics over the past decade, focusing on peri-operative and post-operative complications.<h4>Methods</h4>This retrospective cohort study analyzed POP surgeries and short-term complications among women over 18 at a tertiary medical center from 2014 to 2022. Exclusion criteria included pelvic radiation, malignancy, significant comorbidities, incomplete records, or loss to follow-up. Complications were assessed using the Clavien-Dindo Classification, focusing on infection rate, antibiotic use, blood transfusions, readmission within 30 days, and Intensive care unit admission. Univariate analysis and logistic regression were performed.<h4>Results</h4>The study included 490 women, with 239 in 2014 and 251 in 2022. A decrease in invasive procedures, such as vaginal hysterectomy (25.1 % vs. 15.1 %, p < 0.01) and transabdominal hysterectomy (42.7 % vs 23.1 %, p < 0.01), alongside an increase in native tissue repairs like sacrospinous ligament fixation (SSLF) (2.1 % vs. 27.5 %, p < 0.01), anterior colporrhaphy (14.6 % vs. 24.7 %, p < 0.01), and posterior colporrhaphy (0.0 % vs. 2.4 %, p = 0.02), was noted. Additionally, the use of vaginal mesh decreased (4.2 % vs. 1.2 %, p = 0.04). Short-term complications significantly declined, including infection rate (10.9 % vs. 4.4 %, p < 0.01), post-operative antibiotics (10.9 % vs. 4.0 %, p < 0.01) and need for blood transfusion (16.7 % vs. 7.6 %, p < 0.01). SSLF was an independent protective factor against short-term complications (OR = 0.191, CI 0.044-0.826, p = 0.027), adjusted for year and patient age.<h4>Conclusion</h4>Our analysis suggests a shift toward less invasive POP surgeries, potentially contributing to improved short-term outcomes. The increase in native tissue repairs and reduction in hysterectomies may be associated with fewer short-term complications.