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abstract

2 - RISK FACTORS FOR PROLAPSE RECURRENCE- SYSTEMATIC REVIEW AND META-ANALYSIS

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RISK FACTORS FOR PROLAPSERECURRENCE- SYSTEMATIC REVIEW AND META-ANALYSIS

T. FRIEDMAN, G. D. ESLICK, H.DIETZ;
Sydney Med. Sch. Nepean, Sydney, Australia.

Introduction: Female pelvicorgan prolapse (FPOP) is a common condition, that si associated withsignificant impairment of quality of life (1), with a lifetime riskfor surgery of 10-20% (2, 3). Prolapse surgery is known to have ahigh reoperation rate (30%). Little is known about the factorsassociated with surgical failure. It is plausible that factorsplaying a role in POP etiology may also be risk factors for POPrecurrence. There are several reviews/ systematic review available toevaluate risk factors for prolapse and prolapse recurrence. However,we have not been able to identify a recent meta-analysis on thisissue.
Objective: To perform a systemic review andquantitative meta-analysis in order to determine risk factors forrecurrence of prolapse after surgery.
Methods: Fourelectronic databases (Medline, PubMed, Embase and Google Scholar)were searched between 1995 and January 1st 2017 with nolanguage restrictions. From 3549 citations identified, a total of 26studies met the following inclusion criteria: (1) risk factors forrecurrence of prolapse were investigated; (2) the risk point estimatewas reported as an odds ratio (OR), or the data was presented suchthat an OR could be calculated; (3) the 95% confidence interval (CI)was reported, or the data was presented such that the CI could becalculated; (4) an internal comparison was used when calculating therisk estimate. We excluded studies that did not meet inclusioncriteria.
Results: Overall 26 studies met our inclusioncriteria with a sum of 6246 patients. 8 Studies were performed inEurope, 12 in America, 1 in Asia and 5 in Australia. The categorieson which a meta-analysis could be performed included: age -11studies, BMI -12 studies, staging of prolapse pre-operatively -10studies, levator avulsion-9 studies, Parity-7 studies,constipation/straining-6 studies, Number of compartments involved-5studies, Familial history and Hiatal area on valsalva-3 studies each.Several more parameters were evaluated by 2 studies each. For eachparameter a meta-analysis was undertaken. Meta-analysis that yieldedsignificant odds ratios (OR) and confidence intervals (CI) were foundfor: (1) levator avulsion with OR of 2.86 and CI 2.09-3.91, P-value<0.01. (2) Pre-operative staging 3, 3-4, 4 with OR of 2.08, 2.31,2.38 and CI 0.57-7.61, 1.62-3.29, and 1.49-3.78 respectively. (3)Familial history with OR of 1.84 and CI 1.19-2.86, P-value <0.01.For all other parameters ORs did not reach significance.


Figure 1: Levator avulsion aspredictor of prolapse recurrence


Figure 2: Pre-operative staging aspredictor of prolapse recurrence
Conclusions: Onmeta-analysis, levator avulsion, pre-operative prolapse stage andfamily history were found to be significant risk factors for prolapserecurrence after reconstructive surgery. Avulsion was identified asthe strongest individual predictor. Patients should be informedaccordingly.
References:
1. Obstet Gynecol2009;113(3):609.
2. Obstet Gynecol 1997;89(4):501-6.
3. ObstetGynecol 2010;116(5):1096-100.