Complications of obliterative versus reconstructive vaginal surgery for pelvic organ prolapse in octogenarians: A retrospective cohort study.

AIMS: Women of advanced age may choose between restorative or obliterative surgery for surgical management of pelvic organ prolapse. Obliterative surgery is traditionally reserved for a subset of older women with more severe medical comorbidities, since obliterative approaches are generally considered to be less morbid and older individuals have higher rates of perioperative complications than younger cohorts. This study compared perioperative complications amongst octogenarians undergoing obliterative versus reconstructive approaches. This data will help to inform perioperative counselling as previous studies have not been powered to evaluate complications in this population. METHODS: The National Surgical Quality Improvement Program database was used to identify patients that had Pelvic organ prolapse surgery between 2012 and 2021, aged 80 years or older. Single-compartment procedures, vaginal mesh procedures, and oncologic surgery were excluded. The primary outcome was any complication within the first 30 days excluding urinary tract infection (UTI). UTI, readmission, and severe complications were secondary outcomes. RESULTS: Of the 4149 patients identified, 2514 (60.6%) underwent reconstructive surgery and 1635 (39.4%) underwent obliterative surgery. Patients undergoing reconstructive surgery were more likely to have an American Society of Anesthesiologists (ASA) class of 1 or 2 (46.1% vs. 31.3%, p = 0.002) and were less likely to be on antihypertensive medication (72.0% vs. 75.8%, p = 0.006). Further, there was an increased length of stay (1.47 ± 1.84 vs. 1.03 ± 1.31 days, p < 0.001) in hospital for reconstructive surgery which was more often performed as an inpatient (45.7% vs. 37.9%, p < 0.001). There was no difference in the primary outcome: any complication excluding UTIs. However, UTI was more common in the reconstructive group (aOR 0.48; 95% confidence interval 0.34-0.0). The rate of serious complications (Clavien-Dindo Class IV) was low overall and not different between reconstructive and obliterative approaches (1.3% vs. 1.0%, respectively). CONCLUSIONS: Both vaginal reconstructive and obliterative approaches have low complication rates in octogenarians, with only UTI rate being different between cohorts. When choosing surgical approach, we suggest a case-based, patient center discussion on the anatomic outcomes, durability and patient satisfaction.

Short term complications in mesh augmented vaginal repair of pelvic organ prolapse are not higher when compared with native tissue repair.

INTRODUCTION AND HYPOTHESIS: Accumulating evidence regarding the negative long-term consequences of transvaginal mesh-based procedures for pelvic organ prolapse has led to a sharp decline in mesh-based procedures. We aimed to evaluate the short-term complications of mesh-based procedures for carefully selected patients with pelvic organ prolapse after Food and Drug Administration warnings. METHODS: A retrospective database review of the ACS NSQIP database was completed to examine 30-day complications including re-operation, prolonged length of stay, blood transfusion, surgical site infection, urinary tract infection, readmission and wound dehiscence in mesh-augmented and native tissue-based transvaginal procedures for pelvic organ prolapse. RESULTS: A total of 36,234 patients were included in the analysis, with only 7.1% (2574 women) having mesh-augmented repair. Using a multivariable logistical regression analysis adjusting for confounders, we found that the primary composite outcome (re-operation, hospital stay, blood transfusion and surgical site infection) was less common in the mesh group compared with the native tissue repair group (adjusted OR 0.80, CI 0.67-0.95, p = 0.009). The secondary outcomes (urinary tract infection, re-admission and wound dehiscence) were not different between the group. CONCLUSION: These results suggest that in well-chosen patients, short-term complications are not increased when using transvaginal mesh for pelvic organ prolapse repair.

Association between obstetrical anal sphincter injury and postpartum urinary retention: a contemporary nationwide cohort study.

INTRODUCTION AND HYPOTHESIS: Identification and prompt management of postpartum urinary retention after vaginal birth is essential to minimize long-term morbidity. Obstetrical anal sphincter injuries (OASIS) have been identified as a possible risk factor for urinary retention. The objective of this study was to estimate the association between OASIS and postpartum urinary retention and compare the length of hospital stay and cost of admission between postpartum patients who experienced urinary retention and those who did not. METHODS: We conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses via vaginal birth in the United States using the National Inpatient Sample (NIS) database. Multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between OASIS and postpartum urinary retention. Simple linear regression was used to compare means. RESULTS: A total of 2,013,052 delivery admissions were included, which was representative of a population size of 10,065,253 utilizing the complex sampling design of the NIS database. 47,192 (2.34%) admissions sustained OASIS and 5,339 (0.27%) admissions experienced overt urinary retention. After adjusting for potential confounders, vaginal deliveries where OASIS occurred had 3.60 times the odds of postpartum urinary retention compared with vaginal deliveries where OASIS was not sustained (95% CI 3.26-3.97). Postpartum urinary retention was associated with an increased mean length of stay (2.94 vs 2.28 days, p<0.001) and 1.37 times the mean total cost of admission (US$22,946.38 vs US$16,758.85, p<0.001). CONCLUSIONS: Obstetrical anal sphincter injuries are associated with increased odds of postpartum urinary retention compared with vaginal deliveries where OASIS did not occur.

Preoperative anemia and complications after surgery for pelvic organ prolapse: an analysis of the national surgical quality improvement program database.

INTRODUCTION AND HYPOTHESIS: Preoperative anemia is a well-established risk factor for adverse perioperative outcomes in major surgery, but studies exploring complications after pelvic reconstructive surgery are limited. The objective of this study is to examine the impact of preoperative anemia on 30-day adverse outcomes in patients undergoing pelvic organ prolapse surgery. METHODS: A retrospective cohort of women undergoing pelvic organ prolapse surgery was captured from the National Surgery Quality Improvement Program database (2014-2019). The primary outcome was a composite of postoperative medical complications such as pulmonary embolism, acute renal failure, stroke, myocardial infarction, cardiac arrest, deep vein thrombosis, and sepsis. Secondary outcomes included surgical site infection, bleeding requiring blood transfusion, readmission within 7 days of surgery, and return to the operating room within 30 days. Multivariate logistic regression was used to adjust for important pre-specified potential confounders. RESULTS: A total of 50,848 women were included in the analysis and 9.9% (4,579) met the criteria for anemia (hematocrit <36%). Potentially serious medical complications were rare, occurring in only 348 women (0.7%), and were more common among anemic patients (1.1% vs 0.6%, p < 0.001). On multivariate analysis, preoperative anemia was associated with higher odds of both potentially serious medical complications (OR 1.38, 95% CI 1.01-1.88) and returning to the operating room (OR 1.55, 95% CI 1.23-1.94). Anemic patients had a four-fold increase in the odds of requiring a blood transfusion (OR 4.47, 95% CI 3.60-5.56). CONCLUSIONS: Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in women having surgery for pelvic organ prolapse.

Complications Following Posterior Colporrhaphy With and Without Anal Sphincteroplasty: An Analysis of Cases in the National Surgical Quality Improvement Program Database.

OBJECTIVE: We aimed to compare postoperative complications for patients undergoing posterior colporrhaphy with or without sphincteroplasty. METHODS: A retrospective cohort of women undergoing posterior colporrhaphy with or without anal sphincteroplasty was completed using the National Surgery Quality Improvement Program (NSQIP) database (2012-2019). The primary outcome was a composite of important surgical complications, including wound complications, blood transfusion, hospital stay >48 hours, reoperation, readmission, and urinary tract infection. Multivariable logistic regression was used to adjust for important potential confounders, including age, BMI, diabetes, and anterior prolapse surgery. RESULTS: A total of 5079 patients were included. Of these, 82 patients underwent a concurrent sphincteroplasty. The primary composite outcome occurred in 10.4% of patients having posterior colporrhaphy versus 19.5% having posterior colporrhaphy with sphincteroplasty. On multivariable analysis there was no increased odds of complication associated with concomitant anal sphincteroplasty (1.58, 95% CI 0.89-2.90, P = 0.12). CONCLUSION: Nearly one in five women who have posterior colporrhaphy with anal sphincteroplasty had an important surgical complication. Higher complication rates may be related to patient factors, as this was not observed after adjustment for patient factors and additional surgical procedures. Sphincteroplasty may be considered with posterior colporrhaphy in select women.

Risk Factors for Urologic Injury in Women Undergoing Hysterectomy for Benign Indication.

OBJECTIVE: To investigate risk factors associated with urologic injury in women undergoing hysterectomy for benign indication. METHODS: A retrospective cohort study for the period of 2011-2018 was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Women without urologic injury were compared with women with injury. A pre-specified multivariable logistic regression model, controlling for key patient demographic factors and intraoperative variables, was used to assess for surgical factors associated with urologic injury. RESULTS: Among 262 117 women who underwent hysterectomy for benign indication, 1539 (0.6%) sustained urologic injury. On average, patients with urologic injury were younger, had lower body mass index (BMI), and more frequently underwent a transabdominal surgical approach. Patients who underwent total hysterectomy had increased odds of urologic injury than those who underwent subtotal hysterectomy (adjusted OR [aOR] 1.49; 95% confidence interval [CI] 1.21-1.84). Patients with class III obesity had lower odds of injury than patients with normal BMI (aOR 0.64; 95% CI 0.51-0.80). For risk of urologic injury, an interaction was observed between surgical approach and surgical indication. Abdominal compared with laparoscopic approach was associated with urologic injury for women with endometriosis (aOR 2.98; 95% CI 1.99-4.47), pelvic pain (aOR 3.51; 95% CI 1.74-7.08), menstrual disorders (aOR 4.33; 95% CI 1.68-11.1), and fibroids (aOR 2.28; 95% CI 1.72-3.03). Vaginal compared with laparoscopic approach was associated with increased odds of injury for women with menstrual disorders (aOR 7.62; 95% CI 1.37-42.5). CONCLUSION: While the risk of urologic injury during hysterectomy for benign indication is low, the risk is dependent on patient disease factors and surgical approach.

Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using data from the National Surgical Quality Improvement Program Database (NSQIP).

INTRODUCTION AND HYPOTHESIS: To define the reasons for hospital readmissions following surgery for pelvic organ prolapse by surgical approach. METHODS: Patients undergoing surgery for pelvic organ prolapse from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology and International Classification of Diseases codes. Hazard risks of readmission by surgical approach (vaginal, laparoscopic, abdominal, or combined) were determined by multivariable cox regression. Diagnoses and timing of readmission by surgical approach were examined. RESULTS: Of 57,233 women undergoing surgery for pelvic organ prolapse during the study period, 1073 (1.9%) were readmitted to the hospital within 30 days postoperatively. After adjusting for prespecified potential confounders, laparoscopic and abdominal surgical approaches were associated with higher risks of readmission relative to a vaginal approach (aHR 1.30, 95% CI 1.08-1.57, and 1.97, 95% CI 1.44-2.71, respectively). The most common reason for readmission was a gastrointestinal issue among those undergoing both laparoscopic (28.0%) and abdominal surgery (30.2%). Surgical site infection was the most common readmission diagnosis among women undergoing vaginal surgery (16.2%). Of the 418 women readmitted within 7 days of surgery, the most common diagnoses were gastrointestinal issues (26.6%), medical disorders (12.0%), or surgical complications (e.g., bleeding) (11.0%). CONCLUSIONS: Women undergoing laparoscopic or abdominal surgery for pelvic organ prolapse were at higher risk of readmission relative to those undergoing surgery via a vaginal approach. The reasons and timing of readmission differed based on surgical approach.

Effect of Surgical Trainee Presence on Vaginal Hysterectomy Outcomes.

STUDY OBJECTIVE: Because of the rapid decline in vaginal hysterectomy (VH) cases in recent years, there is concern regarding gynecologic surgical training and proficiency for VH. The objective of this study is to determine the effect of surgical trainee involvement on surgical outcomes in VH cases performed for benign indications. DESIGN: Retrospective, multicenter, cohort study (Canadian Task Force classification II-2). SETTING: Participating hospitals in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) at various international sites. PATIENTS: Women who underwent VH for benign indication enrolled from the ACS-NSQIP from 2006 to 2012. INTERVENTION: ACS-NSQIP database. MEASUREMENTS AND MAIN RESULTS: Our study included 5756 patients who underwent VH, and surgical trainees were present in 2276 cases (39.5%). Patients who had a trainee present during VH were more likely to be older, nonsmoking, have comorbidities, and be classified as American Society of Anesthesiologists class III or IV. They were also more likely to be admitted as inpatients, undergo concomitant adnexal surgery, and have uterine weight greater than 250 g. Trainee presence during VH was associated with increased rates of overall complications (5.1% vs 3.19%, p < .001), urinary tract infection (5.27% vs 2.64%, p < .001), and operative time (124.25 ± 59.29 minutes vs 88.64 ± 50.9 minutes, p < .001). After controlling for baseline characteristics, trainee presence was associated with increased odds of overall complications (adjusted odds ratio, 1.63; 95% confidence interval, 1.25-2.13), urinary tract infection (adjusted odds ratio, 2.02; 95% confidence interval, 1.51-2.69), and prolonged operative time (adjusted odds ratio, 3.65; 95% confidence interval, 3.20-4.15). No differences were observed for other measures of surgical morbidity or mortality. CONCLUSION: Despite the increased patient complexity and operative time associated with teaching cases, the involvement of surgical trainees is associated with urinary tract infection but not with any major surgical morbidity or mortality. These findings have important implications for gynecologic surgical training for VH.

Water-Related Vaginal Injury: A Case Report and Review of the Literature.

BACKGROUND: Vaginal injury can result from entry of water into the vagina under high pressure. Previously reported cases describe water-jet vaginal injuries in women participating in water-related activities, including: water skiing, personal watercraft use, waterslides, water hose and fountains, with and without foreign body in situ. CASE: We describe the case of a severe vaginal laceration and hemorrhage in a 44-year-old female from a high-pressure water-jet generated during a water-ski fall requiring operative repair. Timely management resulted in excellent patient outcome. CONCLUSION: A literature review demonstrated that, although uncommon, watersport-related gynaecologic injuries can be life-threatening, and women who regularly engage in watersports can be counselled regarding potential preventative measures. Physicians encountering patients with these injuries should rule out intraperitoneal injury and consider benefits of antibiotics.

Complete Mesh Infection Following Repeat Retropubic Tension-Free Vaginal Tape.

BACKGROUND: Midurethral slings are the most widely used surgical treatment for stress urinary incontinence. Complications include bladder injury, voiding dysfunction, mesh exposure/erosion, dyspareunia, and failure to correct the incontinence. Complete mesh infection is rare. CASE: A 48-year-old woman underwent a repeat retropubic tension-free vaginal tape (TVT) procedure for stress urinary incontinence. She presented eight weeks postoperatively with a tender suprapubic mass and urinary retention. A CT scan demonstrated thickening of the bladder wall and cystoscopy revealed severe inflammation with no intramural injury. The sling appeared to be infected and was removed vaginally. The patient's symptoms resolved following removal of the sling. CONCLUSION: Mesh infection following a midurethral sling procedure is rare. In suspected cases, cystoscopy should be performed to rule out bladder injury. Antibiotic therapy may be successful, but removal of the sling may be required for resolution of symptoms.

Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.

OBJECTIVE: To review the evidence relating to obstetrical anal sphincter injuries (OASIS) with respect to diagnosis, repair techniques and outcomes. To formulate recommendations as to patient counselling regarding route of delivery for subsequent pregnancy after OASIS. OPTIONS: Obstetrical care providers caring for women with OASIS have the option of repairing the anal sphincter using end-to-end or overlapping techniques. They may also be involved in counselling women with prior OASIS regarding the route of delivery for future pregnancies. OUTCOMES: The outcome measured is anal continence following primary OASIS repair and after subsequent childbirth. EVIDENCE: Published literature was retrieved through searches of Medline, EMBASE, and The Cochrane Library in May 2011 using appropriate controlled vocabulary (e.g., anal canal, obstetrics, obstetric labour complication, pregnancy complication, treatment outcome, surgery, quality of life) and key words (obstetrical anal sphincter injur*, anus sphincter, anus injury, delivery, obstetrical care, surgery, suturing method, overlap, end-to-end, feces incontinence). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS: Benefits from implementation of these guidelines include: improved diagnosis of OASIS, optimal functional outcomes following repair, and evidence-based counselling of women for future childbirth.

Objectif : Analyser les données probantes traitant des lésions obstétricales du sphincter anal (LOSA) en ce qui concerne leur diagnostic, les techniques visant leur réparation et les résultats de l'intervention. Formuler des recommandations permettant d'éclairer les conseils offerts aux patientes ayant connu des LOSA en ce qui a trait à la voie d'accouchement à privilégier dans le cadre des grossesses subséquentes. Options : Les fournisseurs de soins obstétricaux qui comptent des patientes ayant connu des LOSA disposent de l'option de réparer le sphincter anal en faisant appel à la méthode de suture « bout à bout ¼ (end-to-end) ou à la méthode « en paletot ¼ (overlapping). Ils pourraient également être appelés à conseiller des femmes ayant déjà connu des LOSA en ce qui a trait à la voie d'accouchement à privilégier pour les grossesses subséquentes. Issues : Le critère d'évaluation était la continence anale à la suite d'une réparation primaire de LOSA et à la suite d'un accouchement subséquent. Résultats : La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans Medline, EMBASE et The Cochrane Library en mai 2011 au moyen d'un vocabulaire contrôlé (p. ex. anal canal, obstetrics, obstetric labour complication, pregnancy complication, treatment outcome, surgery, quality of life) et de mots clés (p. ex. obstetrical anal sphincter injur*, anus sphincter, anus injury, delivery, obstetrical care, surgery, suturing method, overlap, end-to-end, feces incontinence) appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs. Aucune restriction n'a été imposée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en septembre 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau). Avantages, désavantages et coûts : Parmi les avantages de la mise en œuvre de la présente directive clinique, on trouve : l'amélioration du diagnostic des LOSA, l'obtention d'issues fonctionnelles optimales à la suite de la réparation et l'offre de conseils reposant sur des données probantes aux femmes en ce qui concerne leurs futures grossesses. Déclarations sommaires 1. Les lésions obstétricales du sphincter anal mènent à des comorbidités considérables, dont l'incontinence anale, les fistules rectovaginales et la douleur. (II-2) 2. Les lésions obstétricales du sphincter anal sont plus souvent associées aux accouchements par forceps qu'aux accouchements par ventouse obstétricale. (II-2) 3. Réparation des lésions obstétricales du sphincter anal : a. L'utilisation de polyglactin 2-0 ou de polydioxanone 3-0 donne lieu, après six semaines, à des taux semblables de morbidité liée aux sutures. (I) b. La réparation du sphincter anal interne est recommandée puisque les femmes chez lesquelles la présence d'une anomalie affectant ce sphincter est révélée au cours de l'échographie postpartum sont plus susceptibles de connaître une incontinence anale. (III) c. La réparation du sphincter anal externe devrait englober la gaine fasciale. Le recours à la technique de suture « en paletot ¼ (chevauchement) nécessite souvent une mobilisation et une dissection de plus grande envergure des extrémités du sphincter; l'utilisation de cette technique n'est possible qu'en présence de déchirures sphinctériennes de degré 3b ou plus. (III) d. La présence persistante d'une anomalie du sphincter anal externe longtemps après l'accouchement pourrait accroître le risque de voir apparaître une aggravation des symptômes à la suite des accouchements vaginaux subséquents. (II-2) 4. Les lésions obstétricales du sphincter anal sont associées à une hausse du risque de rétention urinaire postpartum. (II-2) 5. À la suite de la réparation réussie d'une lésion obstétricale du sphincter anal, la plupart des femmes peuvent connaître un accouchement vaginal en toute sûreté dans le cadre d'une grossesse subséquente. (III) 6. Services de counseling offerts aux femmes au sujet de leurs accouchements subséquents : a. Le risque de récurrence d'une lésion obstétricale du sphincter anal dans le cadre d'un accouchement subséquent est de 4-8 %. (II-2) b. On a calculé que, pour prévenir un cas d'incontinence anale chez des femmes ayant déjà subi une lésion obstétricale du sphincter anal, la tenue de 2,3 césariennes planifiées s'avérerait nécessaire, le tout s'accompagnant alors d'une hausse des risques maternels. (II-2) Recommandations 1. Toutes les femmes devraient faire l'objet d'un examen rigoureux visant la détection de déchirures périnéales ou vaginales; celles qui présentent une déchirure dont la profondeur est plus que superficielle devraient, avant la mise en œuvre d'une réparation, faire l'objet d'un examen rectal systématique cherchant à établir la présence de lésions obstétricales du sphincter anal. (II-2B) 2. Le système de classification de l'Organisation mondiale de la santé devrait être utilisé pour classer les lésions obstétricales du sphincter anal. Ce système permet l'établissement d'une distinction entre le degré de déchirure du sphincter externe (3a < 50 % ou 3b ≥ 50 %) et la présence d'anomalies du sphincter interne (3c). La présence d'une lésion en boutonnière (button-hole injury) constitue un incident distinct et devrait être classée en conséquence. (III-B) 3. Chez les femmes qui connaissent un accouchement vaginal spontané, le taux de lésions obstétricales du sphincter anal est amoindri lorsque le fournisseur de soins obstétricaux ralentit la tête fœtale au moment du dégagement. (II-2A) 4. Épisiotomie : a. Dans le cadre d'un accouchement vaginal spontané ou instrumental, le fournisseur de soins obstétricaux devrait, pour assurer la prévention des lésions obstétricales du sphincter anal, respecter une politique prévoyant une utilisation « restreinte ¼ de l'épisiotomie (c.-à-d. seulement lorsque cela s'avère indiqué), plutôt qu'une utilisation « libre ¼ de cette intervention (c.-à-d. de façon systématique). (I-A) b. Lorsque la tenue d'une épisiotomie est jugée indiquée, l'octroi d'une préférence envers la tenue d'une incision médiolatérale (plutôt qu'envers la tenue d'une incision médiane) devrait être envisagé. (II-2B) L'angle d'incision optimal semble être d'au moins 45 degrés (idéalement, aux alentours de 60 degrés). (II-2B) 5. La réparation peut être différée (pendant 8-12h) sans effets nuisibles. La mise en œuvre d'un délai pourrait s'avérer nécessaire jusqu'à ce que les services d'un fournisseur de soins disposant de l'expérience nécessaire pour procéder à la réparation puissent être retenus. (I-A) 6. L'administration prophylactique d'une dose intraveineuse unique d'antibiotiques (céphalosporine de 2e génération, p. ex. céfotétan ou céfoxitine) devrait être mise en œuvre pour assurer la baisse des taux de complications de lésion périnéale à la suite de la réparation des lésions obstétricales du sphincter anal. (I-A) 7. Des laxatifs (p. ex. lactulose) devraient être prescrits à la suite de la réparation primaire d'une lésion obstétricale du sphincter anal puisqu'ils sont associés à des premières selles moins douloureuses et survenant plus rapidement, et à l'obtention plus rapide du congé de l'hôpital. L'utilisation d'agents constipants et d'agents de gonflement n'est pas recommandée. (I-A) 8. Les anti-inflammatoires non stéroïdiens et l'acétaminophène sont les analgésiques de première intention. Les opioïdes ne devraient être utilisés qu'avec précaution. La constipation devrait être évitée au moyen d'un laxatif ou d'un émollient fécal. (1-A) 9. À la suite de la constatation d'une lésion obstétricale du sphincter anal, les fournisseurs de soins devraient divulguer à leurs patientes le degré de la lésion subie et prendre les dispositions nécessaires à la mise en œuvre d'un suivi. Il est nécessaire de procéder à la documentation détaillée de la lésion et de sa réparation. (III-L) 10. Les femmes qui connaissent une incontinence anale après avoir subi une lésion obstétricale du sphincter anal devraient être orientées vers des services de physiothérapie du plancher pelvien. (I-A).

Outcomes of an Overnight-Stay Unit for Urogynecologic Surgery: Feasibility and Risk Factors for Failure of Next-Day Discharge.

OBJECTIVE: To evaluate outcomes of patients undergoing urogynecologic procedures with postoperative care in an overnight-stay unit at a tertiary care center. METHODS: A retrospective cohort study of 1644 women admitted to an overnight-stay unit at a Canadian tertiary care center after urogynecologic surgery between 2014 and 2018 was completed. A multivariable logistic regression model was fit to identify risk factors for failed next-day discharge, defined as a delayed discharge of more than 24 hours, readmission within 30 days of surgery, or emergency room assessment within 7 days of surgery. RESULTS: One thousand five hundred seventy-eight patients (96%) were discharged within 24 hours of surgery. Mean patient age was 53.7 ± 15.1 years, with 21.2% 70 years or older. Surgical approaches included laparotomies (8.9%), major vaginal surgery (70.9%), and open retropubic procedures (2.1%). Hysterectomies were performed in 1120 patients (68.1%). One hundred one patients (6.1%) were assessed in the emergency department within 7 days of surgery, and 57 (3.5%) were readmitted to hospital within 30 days of their procedure. Multivariable regression identified the following as risk factors for failed next-day discharge: pulmonary disease (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.32-8.06; P = 0.010), longer operating time (OR, 1.40; 95% CI, 1.10-1.79; P = 0.006, per 60 minutes), and intraoperative hemorrhagic complications (OR, 22.64; 95% CI, 5.83-88.00, P < 0.001). CONCLUSIONS: Admission to an overnight-stay unit with next-day discharge is feasible for most patients undergoing urogynecologic surgery. Factors associated with requiring a longer hospital stay, presentation to an emergency department, or readmission to hospital within 7 days include pulmonary disease, longer operating times, and intraoperative hemorrhagic complications.