Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using
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ORIGINAL ARTICLE
Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using data from the National Surgical Quality Improvement Program Database (NSQIP) Aisling A. Clancy 1,2
&
Innie Chen 1,3,4 & Dante Pascali 1,3,4 & Vatche A. Minassian 2,5
Received: 7 June 2020 / Accepted: 17 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis To define the reasons for hospital readmissions following surgery for pelvic organ prolapse by surgical approach. Methods Patients undergoing surgery for pelvic organ prolapse from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology and International Classification of Diseases codes. Hazard risks of readmission by surgical approach (vaginal, laparoscopic, abdominal, or combined) were determined by multivariable cox regression. Diagnoses and timing of readmission by surgical approach were examined. Results Of 57,233 women undergoing surgery for pelvic organ prolapse during the study period, 1073 (1.9%) were readmitted to the hospital within 30 days postoperatively. After adjusting for prespecified potential confounders, laparoscopic and abdominal surgical approaches were associated with higher risks of readmission relative to a vaginal approach (aHR 1.30, 95% CI 1.08– 1.57, and 1.97, 95% CI 1.44–2.71, respectively). The most common reason for readmission was a gastrointestinal issue among those undergoing both laparoscopic (28.0%) and abdominal surgery (30.2%). Surgical site infection was the most common readmission diagnosis among women undergoing vaginal surgery (16.2%). Of the 418 women readmitted within 7 days of surgery, the most common diagnoses were gastrointestinal issues (26.6%), medical disorders (12.0%), or surgical complications (e.g., bleeding) (11.0%). Conclusions Women undergoing laparoscopic or abdominal surgery for pelvic organ prolapse were at higher risk of readmission relative to those undergoing surgery via a vaginal approach. The reasons and timing of readmission differed based on surgical approach. Keywords Pelvic organ prolapse . Readmission . Vaginal surgery . Minimally invasive surgery
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04505-z) contains supplementary material, which is available to authorized users. * Aisling A. Clancy [email protected] 1
Department of Obstetrics and Gynecology, The Ottawa Hospital, Urogynecology Clinic, The Ottawa Hospital Riverside Campus, 1967 Riverside Drive, Ottawa, ON, Canada
2
T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
3
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
4
Ottawa Hospital Research Institute, Ottawa, ON, Canada
5
Brigham and Women’s Hospital, Boston, MA, USA
Approximately 10–20% of women will undergo surgery for pelvic organ prolapse during their lifetime, most commonly in older a
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