Presentation Authors: Claire S. Burton*, Catherine Bresee, Colby P. Souders, Los Angeles, CA, Alex Hannemann, Vermillion, SD, Karyn S. Eilber, Jennifer T. Anger, Los Angeles, CA
Introduction: Women with pelvic floor disorders may experience both vaginal and rectal prolapse, and several recent reports have proposed the use of concurrent sacrocolpopexy and rectopexy to reduce patient morbidity and improve patient outcomes. We evaluate the temporal trends of concurrent rectopexy and sacrocolpopexy and compare complication rates between individual and concurrent procedures using the National Inpatient Sample (NIS).
Methods: The NIS, maintained by the Healthcare Cost and Utilization Project (HCUP), contains approximately 20% of all hospital admissions in the United States from a stratified sample. We identified women who underwent either sacrocolpopexy (70.77, 70.78) or rectopexy (48.75, 48.76) by ICD-9 procedure codes between 2010-2014.
Results: There were 160,714 women who underwent sacrocolpopexy, 24,493 who underwent rectopexy, and 2,354 who had concurrent sacrocolpopexy and rectopexy during the period of 2010-2014. Rates of sacrocolpopexy decreased from 43,213 in 2010 to 19,840 in 2014 (p < 0.001). Rectopexy rates were unchanged during the overall period from 4,898 in 2010 to 4,985 in 2014 (p=0.64). There was no changed in rates of concurrent procedures (p=0.41). Those with concurrent procedures were more likely to be younger (p < 0.001), have longer length of stay (LOS) (p < 0.001), and higher hospital charges (p < 0.001) than sacrocolpopexy alone, but LOS and hospital charges were no different than rectopexy alone (Table 1). Sacrocolpopexy alone had lower complication rates when comparing any complication, digestive, respiratory, and bowel complications (p < 0.001) vs. either rectopexy or concurrent procedures. No differences in wound, urinary, or cardiovascular complications were seen when comparing concurrent procedures versus either alone.
Conclusions: Women undergoing sacrocolpopexy experience fewer complications than women undergoing rectopexy, but complication rates are not increased by performing concurrent sacrocolpopexy and rectopexy when compared to rectopexy alone. Select patients who desire both sacrocolpopexy and rectopexy may benefit from concurrent procedures without increasing complications, LOS, or hospital charges. The stable trend of concurrent sacrocolpopexy and rectopexy suggests that this combined approach has yet to be widely adopted.