National perioperative outcomes of sacrocolpopexy versus colporrhaphy with apical suspension for pelvic organ prolapse: A retrospective cohort study (2008-2021)

Abstract

Pelvic organ prolapse (POP) affects up to 40% of women and often requires surgical repair, which can result in unfavorable outcomes. We compared perioperative outcomes of anteroposterior colporrhaphy with apical suspension versus minimally invasive sacrocolpopexy (SCP), hypothesizing differences in outcomes between the two approaches. We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2021, including 15,015 women aged 18-89 years. Patients who underwent colporrhaphy with apical suspension (n=6,906) were compared to those who underwent laparoscopic or robotic SCP (n=8,109). We recorded baseline demographics and comorbidities. Primary outcomes included overall complications, infections, urinary tract infections (UTIs), unplanned readmissions, and length of hospital stay. Multivariable logistic regression and 1:1 propensity score matching were used to adjust for confounding factors. Patients undergoing SCP were younger and healthier at baseline. After adjustment, colporrhaphy was associated with significantly higher odds of any complication (adjusted OR 1.34), minor complications (OR 1.42), infections (OR 1.35), UTIs (OR 1.57), and prolonged hospital stay >2 days (OR 1.49). After propensity score matching, rates of complications remained higher in the colporrhaphy group: Overall complications (8.5% vs. 6.5%), infections (6.7% vs. 5.0%), and UTIs (5.6% vs. 3.6%) (all p<0.001). Severe complications, reoperation, and mortality rates were low and similar between groups. Minimally invasive SCP may be associated with more favorable short-term perioperative outcomes than colporrhaphy with apical suspension, supporting its consideration in appropriately selected patients.