Does Living With Human Immunodeficiency Virus Increase Pelvic Reconstructive Surgery Perioperative Complication Risk? A Multicenter Retrospective Cohort Study.

OBJECTIVE: To determine if women with human immunodeficiency virus (HIV) undergoing pelvic reconstructive surgery (PRS) have an increased risk of perioperative and postoperative complications compared with HIV-negative controls. STUDY DESIGN: Multicenter, retrospective matched cohort study of patients with and without HIV infection who underwent PRS between 2006 and 2016. Cases were identified using International Classification of Disease, 9th edition Clinical Modification and 10th edition Clinical Modification and current procedural terminology (CPT) codes encompassing HIV diagnoses and pelvic reconstructive surgeries. Controls were identified as patients without HIV who underwent similar procedures, performed by the same surgeon during the same 1-year period as surgeries performed on patients with HIV. Cases were matched to controls at a ratio of 1:3. The primary outcome was composite complication rate within 1 year of surgery. RESULTS: Sixty-three patients with HIV and 187 controls were identified. There was no difference in the composite complication rate between women with HIV and HIV-negative women (36.5% vs 30.0%, P = 0.15) over 1 year. However, 19.1% of patients with HIV compared with 5.4% controls had Clavien Dindo Grade I complications (P = 0.002), and 11.1% of HIV patients had urinary retention within 6 weeks of surgery compared with 3.2% of controls (P = 0.02). After multivariable logistic regression used to adjust for confounders, living with HIV was not associated with an increased risk of complications. CONCLUSIONS: Patients living with HIV are not at an increased risk of complications within 1 year of PRS compared with patients without HIV.

Racial Differences in Pelvic Organ Prolapse Symptoms Among Women Undergoing Pelvic Reconstructive Surgery for Prolapse.

OBJECTIVE: The aim of this study was to determine if there is a difference in Pelvic Floor Disability Index Questionnaire (PFDI-20) scores between black and white women seeking surgical management for pelvic organ prolapse (POP). METHODS: A retrospective cohort study of 232 women who underwent pelvic reconstructive surgery with apical suspension for POP was performed. Demographic and clinical data were collected. All women completed the PFDI-20 and had a Pelvic Organ Prolapse Quantification examination at the initial consultation. Appropriate statistical tests were used to compare black and white women. Multivariable regression models adjusting for demographic and clinical variables were developed to determine the independent relationship between race and POP symptoms. RESULTS: In our cohort, 174 (75%) were white and 58 (25%) were black. Compared with white women, black women had higher parity, body mass index, Charlson Comorbidity Index score, and anterior POP stage. White women had higher total PFDI-20 scores corresponding to higher scores on all symptom subscales. After controlling for potential confounders, white race and prior anti-incontinence surgery remained associated with higher total PFDI scores. Higher Urogenital Distress Inventory 6 scores were significantly associated with white race, prior anti-incontinence procedures, and increasing body mass index, whereas higher CRADI-8 scores were associated with prior anti-incontinence surgery and higher POP stages. CONCLUSIONS: White women appeared to have more overall symptom bother from prolapse, as well as urinary symptoms, as compared with black women, when assessed by validated questionnaire tools in a cohort of patients who underwent prolapse surgery. Further research is required to determine if racial differences in symptoms translate to differences in outcomes.

Ureteral Compromise in Laparoscopic Versus Vaginal Uterosacral Ligament Suspension: A Retrospective Cohort.

OBJECTIVES: The aim of this study was to evaluate if ureteral compromise is significantly different between laparoscopic and vaginal uterosacral ligament suspension (USLS). METHODS: This is a retrospective cohort study comparing all women who underwent laparoscopic and vaginal USLSs at 2 institutions (part of a single training program with procedures performed by 11 fellowship-trained Female Pelvic Medicine and Reconstructive Surgery gynecologic surgeons) between January 2008 and June 2013. RESULTS: A total of 208 patients in the study underwent a USLS, 148 in the laparoscopic group and 60 in the vaginal group. At baseline, there were statistically significant differences between the groups in mean age (50.4 vs 55.3 years, P = 0.008), parity (2.44 vs 2.77, P = 0.040), and prior hysterectomy (3.4% vs 11.7% in the laparoscopic and vaginal groups, respectively; P = 0.042).There were no ureteral compromises in the laparoscopic group and 6 in the vaginal group (0.0% vs 10.0%, respectively; P < 0.001). In an analysis evaluating only those ureteral compromises requiring stent placement, the higher rate of ureteral compromise in the vaginal group persisted despite exclusion of those cases requiring only suture removal and replacement (0.0% vs 5.0% in the laparoscopic and vaginal groups, respectively; P = 0.023).There was a lower median blood loss in the laparoscopic group (137.5 vs 200.0 mL, respectively; P = 0.002) as well as a lower rate of readmission (0.7% vs 6.7%, respectively; P = 0.025). There were no other significant differences in postoperative complications between the 2 groups. CONCLUSIONS: We found a lower rate of ureteral compromise in the laparoscopic approach to USLS compared with the traditional vaginal approach.