POST OPERATIVE COMPLICATIONS RATESBASED ON VAGINAL APPROACH FOR PROLAPSE: RESULTS FROM THE NATIONALSURGICAL QUALITY IMPROVEMENT PROGRAM (SNQIP) DATABASE
K. SMITH, D. LAZARE, L.STOTHERS;
Univ. of British Columbia, Vancouver, Canada.
Introduction: Vaginal approachesto surgical therapy can involve individual or combined anatomiccompartments in the pelvis and may or may not involve surgery relatedto the bowel. The compartments vary in their bacterial flora. Bowelflora are known to be a risk factor for UTI.
Objective: Thepurpose of this study was to determine if varying surgical exposuresare linked to UTI risk in the early post operative period followingvaginal surgery and to examine the influence of mesh implantation inthis setting.
Methods: The NSQIP database was searched forall vaginal operations for POP based on CPT codes, then by CPT codes572/40,50,60,65,67,68,82,83,88 individually then grouped by surgicalapproach to the anterior compartment, posterior compartment orcombined compartments. Intra operative and 30-day post-operativerates were analyzed.
Results: In 2014, 6948 vaginalsurgeries were reported with a 30 day post-operative occurrence rateoverall of 5.2%. 1.8% had readmission for any reason within 30 days.No cases of progressive renal insufficiency or acute renal failurewere reported. Urinary tract infection occurred in 3.4%. Transfusionoccurred in 0.7% of patients within 72 hours of surgery; DVT was seenin 0.1% and sepsis in 0.1%. In 2015, 7648 vaginal surgeries werereported in 2014 with a 30 day post-operative occurrence rate overallof 5.6%. 2% had readmission for any reason within 30 days. No casesof progressive renal insufficiency or acute renal failure werereported. Urinary tract infection occurred in 3.7%. Transfusionoccurred in 0.6% of patients within 72 hours of surgery; DVT was seenin 0.1% and sepsis in 0.1%. In anterior compartment surgery alone,readmission rates for any reason within 30 days was 1.8% with 1.6%having an unplanned return to the operating room. UTI was the mostcommon complication at 4.6%. In posterior compartment surgery alone,overall 30 days post-operative complications occurred in 5.3%. 2.1%had an unplanned readmission within 30 days with 1.3% returning tothe operating room. UTI was the most common complication occurring in3.6%. In surgeries involving both the anterior and posteriorcompartment, overall 30 day post operative complications occurred in5.8%. 2.2% had an unplanned readmission within 30 days with 1.5%returning to the operating room. UTI was the most common complicationoccurring in 4% Surgical implantation of mesh had a 4.4% overall 30days post-operative complication rate with a 1.5% readmission rate,with 1.3% requiring an unplanned return to the operating room. UTIwas reported in 3.3%.
Conclusions: Vaginal surgery in thevarying anterior, posterior and apical compartments was notinfluential on the UTI rate and surgeries involving the posteriorcompartment including rectocele did not influence UTI rates.Alternative risk factors for UTI such as the genetics of the bacteriaare therefore alternative hypothesis which drive UTI in thissetting.