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206 - OUTCOMES OF PELVIC ORGAN PROLAPSE SURGERY: DOES BMI MATTER?

206

OUTCOMES OF PELVIC ORGAN PROLAPSE SURGERY: DOES BMI MATTER?

DEVAKUMAR, N. CHANDRASEKARAN, L. MARTIN, G. DAVILA, E. A. HURTADO;
Cleveland Clinic Florida, Weston, FL.

Introduction: There is a reported positive relationship between pelvic organ prolapse (POP) and obesity1. Long term follow up of individuals after hysterectomy showed a 4.4% rate of vaginal vault prolapse with obesity as the strongest risk factor for its occurrence2. However there is paucity of evidence examining pelvic organ prolapsed (POP) surgical outcomes in obese individuals.
Objective: To evaluate long term outcomes of POP surgery in obese (body mass index (BMI) ≥ 30) compared to non-obese (BMI of < 30) individuals.
Methods: This was a retrospective review of obese and non-obese patients with a diagnosis of vaginal vault prolapse who underwent surgical treatment from 2003 to 2015 using a prospective urogynecologic database. Primary outcome of success was defined as < stage 2 (POPQ and Baden walker) and a patient reported satisfaction of “cured” or “greatly improved” on a validated patient improvement satisfaction score.
Results: There were 674 subjects; 542 with BMI <30 (group 1) and 132 with BMI ≥ 30 (group 2). Mean follow up was 165.0 and 180 weeks in groups 1 and 2 respectively.13% of women in group 2 were diabetic compared to 7% in group 1(p= 0.013) and more subjects in group 1 had undergone prior POP surgeries (18.4 vs 9.0, p= 0.0096). Interestingly, the operating time was longer in the group 1 (39.42 minutes vs 27.95, p=0.037). Estimated blood loss was greater in group 2 compared to group1 (139.2 vs 168.4, p= 0.0012). The surgical approaches to correct POP were different in both groups. Vaginal route was more commonly used in group 2 (96.21 vs 88.75, p=0.009) and the abdominal route in group 1(11.4% vs 4.55%, p=0.018). Table 1 describes all baseline demographics. For the primary outcome, there was no difference in outcomes of success (53.14% vs 52.27%, p=0.85). The recurrence rates, reoperation rates were no different in both groups (table 2).
Conclusions: Long term outcomes after surgical correction of vaginal vault prolapse are not different between obese and non-obese individuals. Complication rates and recurrence rates are comparable between the 2 groups.
References: 1. Acta Obstet Gynecol Scand. 2004; 83:383-9. 2. Journal. Reproductive Medicine 1999 Aug; 44(8):679-84.

Table 1

Age

71.7 (10.64)

72.58 (10.12)

0.39

BMI

24.96 (2.7)

33.2 (3.12)

<0.001

Parity

2 (2,3)

2 (2,3)

0.68

Smoking

19 (3.51)

5 (20.83)

0.87

Diabetes

38 (7.01)

18 (13.64)

0.013

Menopause

60 (11.07)

19 (14.39)

0.287

Prior Hysterectomy

219 (40.41)

49 (37.12)

0.489

Prior POP Surgeries

100 (18.45)

12 (9.09)

0.0096

Estimated blood loss

139.28 (87.76)

168.48 (107.61)

0.0012

Time (minutes)

39.42(61.98)

27.95 (55.03)

0.037

Abdominal Repair

62 (11.44)

6 (4.55)

0.0184

Vaginal Repair

481 (88.75)

127 (96.21)

0.0096

 

Table 2

 

Group 1 (542)

Group 2 (132)

 

Primary Outome

288 (53.14)

69 (52.27)

0.85

Anatomic Success

441 (81.37)

112 (84.85)

0.34

Subjective Success

333 (61.44)

79 (59.85)

0.73

Palpable Prolapse

49 (9.04)

8 (6.06)

0.26

Apical Recurrence

8 (1.63)

2 (1.57)

1

Anterior recurrence

74 (15.13)

15 (11.81)

0.342

Posterior recurrence

22 (4.49)

5 (3.94)

1

Complications

13 (2.42)

6 (4.55)

0.181

Pessary Use

10 (1.85)

0

0.223