Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse.
To determine the rate of perioperative complications and cost associated with Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse.



We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery (MMC, ASC, or RSC) between January 1, 2000, and June 30, 2012, at our institution. For all patients identified, perioperative complications, length of hospital stay, and inpatient costs to patients were abstracted from the medical records and compared by procedure. Inverse-probability-of-procedure weighting using propensity scores was used to obtain less-biased comparisons of outcomes between procedures.



A total of 512 patients met the inclusion criteria (174 MMC, 237 ASC, and 101 RSC). Using inverse-probability weighting, the MMC group had a significantly lower intraoperative complication rate (3.3% vs 11.6% for ASC, 3.4% vs 24.1% for RSC), median operative time (94 vs 217 min for ASC, 100 vs 228 min for RSC), and median cost (US $8,776 vs $12,695 for ASC, US $8,773 vs $13,107 for RSC) than the ASC and RSC groups (all P < 0.01). In addition, the MMC group had significantly fewer postoperative grade 3+ complications than the RSC group (1.1% vs 9.4%, P < 0.01).



In the treatment of posthysterectomy vaginal vault prolapse, MMC is associated with decreased non-urinary tract infection, less perioperative morbidity, and lower cost to patients compared with sacrocolpopexy.
From the *Divisions of Gynecologic Surgery, †Biomedical Statistics and Informatics, and ‡Health Care Policy and Research, Mayo Clinic, Rochester, MN.
Mallika
M
Anand
Amy L
AL
Weaver
Kristin M
KM
Fruth
Bijan J
BJ
Borah
Christopher J
CJ
Klingele
John B
JB
Gebhart
D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007431:Intraoperative Complications / Q000191:economics / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D014621:Vagina / Q000601:surgery*
J Biomed Inform. 2009 Apr;42(2):377-81
18929686
Obstet Gynecol. 2011 Nov;118(5):1005-1013
21979458
Am J Obstet Gynecol. 2008 May;198(5):572.e1-6
18355787
Mayo Clin Proc. 2012 Dec;87(12):1202-13
23199802
Mov Disord. 2006 Nov;21(11):1864-71
16977632
J Chronic Dis. 1987;40(5):373-83
3558716
Eur J Obstet Gynecol Reprod Biol. 2005 Apr 1;119(2):144-55
15808370
Female Pelvic Med Reconstr Surg. 2016 Jul-Aug;22(4):236-42
26945273
Ann Surg. 2004 Aug;240(2):205-13
15273542
Obstet Gynecol. 2009 Feb;113(2 Pt 1):367-73
19155908
Cochrane Database Syst Rev. 2013 Apr 30;(4):CD004014
23633316
Int Urogynecol J. 2016 Feb;27(2):239-46
26294206
Lancet. 2007 Mar 24;369(9566):1027-38
17382829
Clin Obstet Gynecol. 1972 Dec;15(4):1048-54
4649139
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1717-24; discussion 1724-8
1615980
Multivariate Behav Res. 2011 May;46(3):399-424
21818162
Stat Med. 2015 Dec 10;34(28):3661-79
26238958
Int J Epidemiol. 2012 Dec;41(6):1614-24
23159830
Obstet Gynecol. 1998 Aug;92(2):281-5
9699767
Int Urogynecol J. 2013 Nov;24(11):1815-33
24142057