Postoperative appointments: which ones count?
OBJECTIVE
Although postoperative complications in women undergoing reconstructive pelvic surgery (RPS) have been characterized, little is known regarding the timeline of these occurrences. We aimed to determine the timeframe after RPS during which the majority of complications occur, to assist with planning intervals between postoperative visits.


METHODS
Women undergoing RPS were identified through billing information. Demographic, surgical, and complications data were extracted from electronic medical records. The Pelvic Floor Complication scale is a surgical scale tailored to women undergoing RPS. It contains three subscales: intraoperative, immediately postoperative, and delayed complications. We applied this scale to each postoperative visit (at 2, 6, and 13 weeks).


RESULTS
396 women underwent RPS and 125 patients had 179 complications, most of which (66 %) were identified by the 2-week visit. Complications at the 2-week visit consisted of urinary tract infection (UTI; 46 %), wound infection (10.0 %), and urinary retention (9.4 %). The majority of serious complications (venous thromboembolism [VTE], ileus, small bowel obstruction [SBO], readmission, and reoperation [1 incarcerated hernia and 1 sling release]) were diagnosed by 2 weeks. One patient was readmitted for ileus at between 2 and 6 weeks. At between 6 and 13 weeks, 1 patient was readmitted with SBO; 1 VTE was diagnosed; and 1 required reoperation for a prolapsed fallopian tube. In contrast, two thirds of the complications seen at the 13-week visit were due to granulation tissue, suture erosion or mesh erosion.


CONCLUSIONS
The majority of non-mesh-related complications occur within the first 2 weeks after RPS, whereas mesh and suture complications are more likely to be identified at the 13-week visit.
Prentice Women's Hospital, 250 E Superior Street, Suite 05-2370, Chicago, IL, 60611, USA. mgmueller@nm.org.|Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. mgmueller@nm.org.
Margaret G
MG
Mueller
Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
Dana
D
Elborno
Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Bhumy A
BA
Davé
Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Alix
A
Leader-Cramer
Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Christina
C
Lewicky-Gaupp
Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Kimberly
K
Kenton
D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D002641:Chicago / Q000453:epidemiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000601:surgery
Pelvic floor disorders; Postoperative complications; Reconstructive pelvic surgery; Urogynecology