A Comparison of Perioperative Outcomes, Readmission, and Reoperation for Sacrospinous Ligament Fixation, Uterosacral Ligament Suspension, and Minimally Invasive Sacrocolpopexy

Abstract

Objectives Sacrospinous ligament fixation (SSLF), uterosacral ligament suspension (USLS), and minimally invasive sacrocolpopexy (MISC) are common routes for vaginal apical suspension. Comparative data analyzing perioperative adverse events among these 3 routes are sparse. Perioperative morbidity was compared among these 3 approaches. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients older than 18 years undergoing these surgical procedures from 2012 to 2018. Baseline characteristics, postoperative complications, and rates and timing of readmission/reoperation with identification of causes for either were extracted. Logistic regression was used to compare the odds of readmission or reoperation, adjusting for concurrent hysterectomy and the American Society of Anesthesiologists (ASA) score. Results There were 1,881 SSLFs, 975 USLSs, and 4,559 MISCs that were performed from 2012 to 2018. Vaginal approaches were more common in older, non-White women; women with comorbidities; and women with higher ASA scores and performed more often by gynecologists (vs urologists). More concomitant hysterectomies were performed with USLS and MISC than with SSLF (22% and 26% vs 5%). Increased postoperative blood transfusions, urinary tract infections, and overall complications were noted in the vaginal approaches (7% and 7% vs 5%). Minimally invasive sacrocolpopexy had longer operative times. More same-day discharges were observed in USLS and SSLF. Readmission (2%–3%) and reoperation (1%–2%) rates were similar across all routes when adjusted for concomitant hysterectomy and ASA class. The most common indications for readmission were related to bleeding, infection, or bowel issues (MISC). Hemorrhage/hematoma followed by intestinal obstruction was the most common indication for reoperation. Conclusions Overall perioperative safety is comparable in 3 common vaginal apical suspension routes. Readmission and reoperation remain rare after operative colpopexy regardless of route.