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

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.