The association between smoking status and post-operative complications in pelvic organ prolapse corrective surgeries

Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery

OBJECTIVE

The objective of this study was to determine how rates of postoperative infectious complications after pelvic organ prolapse surgery differ based on perioperative antibiotic administered. In particular, we sought to determine whether anaerobic coverage is associated with reduced rates of infectious complications.

DESIGN

This was a retrospective cohort study.

SETTING

Premier Healthcare U.S. national database, a comprehensive all-payer dataset capturing patients from urban and rural nonprofit, community, and teaching hospitals.

PARTICIPANTS

Adult patients who underwent vaginal, laparoscopic, and/or abdominal prolapse surgery with or without hysterectomy from January 2000 to March 2020. Procedures with and without mesh were included.

INTERVENTIONS

Rates of infectious complications were compared among patients who received guideline-concordant antibiotic regimens, including those with anaerobic coverage. The primary outcome was any surgical site infection within 30 days of surgery without mesh or 90 days of surgery involving mesh.

RESULTS

Among 130,198 prolapse surgeries, the most common antibiotic regimens were cefazolin (n = 97,058, 74.5%), second-generation cephalosporin (n = 16,442, 12.6%), clindamycin + aminoglycoside (n = 8,397, 6.4%) and cefazolin + metronidazole (n = 4,328, 3.3%). On multivariable logistic regression, only clindamycin + aminoglycoside was associated with a higher rate of surgical site infections (OR = 1.37; 95% CI 1.09-1.72) and other infectious morbidity (OR = 1.26; 95% CI 1.12-1.42) when compared to cefazolin alone. The addition of metronidazole to cefazolin was not associated with reduced rates of surgical site infections (OR = 1.09; 95% CI 0.82-1.45). Obesity (OR = 1.22; 95% CI 1.03-1.43), diabetes without complication (OR = 1.30; 95% CI 1.08-1.57), Charlson comorbidity score >0 (OR = 1.24; 95% CI 1.06-1.45), and tobacco use (OR = 1.22, 95% CI 1.05-1.40) were also associated with increased composite surgical site infection.

CONCLUSION

Compared with cefazolin alone, the use of alternative perioperative antibiotics, including those with anaerobic coverage, was not associated with reduced infectious complications after pelvic organ prolapse surgery in this U.S. national sample.

Surgical Decision-Making: Who Should Be Offered Sacrocolpopexy?

INTRODUCTION AND HYPOTHESIS

Women undergoing surgery for apical pelvic organ prolapse have several medically sound options for specific surgical approaches.

METHODS

We review the principles of shared decision-making as they pertain to surgery for prolapse. We review the literature supporting the superior sacrocolpopexy as a durable treatment for prolapse and the factors that may differentiate it from other repairs in risk and benefit.

RESULTS

We emphasize the importance of collaboration between patients and surgeons in surgical decision-making.

CONCLUSION

All medically appropriate patients who desire reconstructive surgery for prolapse should be offered sacrocolpopexy.

Obesity and Reconstructive Pelvic Surgery: An ACS NSQIP Study

IMPORTANCE

Obesity is steadily increasing in the United States and is a risk factor for many medical and surgical complications. Literature is limited regarding obesity as an independent risk factor for perioperative complications after reconstructive pelvic surgery (RPS).

OBJECTIVE

This study aimed to analyze the association of obesity on 30-day perioperative complications after RPS.

STUDY DESIGN

This was a database study comparing perioperative complications after RPS of obese versus nonobese patients using the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected, and perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index ≥30 (calculated as weight in kilograms divided by height in meters squared).

RESULTS

A total of 13,302 patients met the inclusion criteria and were included in this study; 4,815 patients were obese, whereas 8,487 were nonobese. The overall rate of any 30-day postoperative complication was 6.8%, and the rate of complications did not differ between groups. Superficial and organ space surgical site infections were significantly higher in the obese cohort, whereas nonobese patients were more likely to receive a blood transfusion. A multivariable logistic regression model was performed with variables that were statistically significant on bivariate analysis and deemed clinically significant. Variables included obesity, age, American Society of Anesthesiologists class, current smoker, diabetes, hypertension, operative time, colpopexy, and obliterative procedure. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative complications after pelvic organ prolapse surgery.

CONCLUSION

Obesity was not associated with 30-day postoperative complications after RPS after controlling for possible confounding variables.