Postoperative Complications and Pelvic Organ Prolapse Recurrence Following Combined Rectal Prolapse and Pelvic Organ Prolapse Surgery Compared to Pelvic Organ Prolapse Surgery Only

The primary objectives were to compare the <30-day postoperative complications and POP recurrence in women undergoing combined pelvic organ prolapse (POP) and rectal prolapse (RP) surgeries to those undergoing POP-only surgery. Multicenter, retrospective case-control study at five academic hospitals and part of the AUGS-SGS Fellows Pelvic Research Network. Patients undergoing combined RP+POP surgery were matched by age, POP stage by leading compartment and POP procedure to those undergoing POP-only surgery from March 2003 and March 2020. Primary outcome measures were <30-day complications separated into Clavien-Dindo (CD) classes as well as 1) subsequent POP surgeries and 2) POP recurrence defined as patients who complained of vaginal bulge symptoms postoperatively. Data and percentages are presented for the combined surgery group followed by POP-only surgery group. Two hundred and four women underwent combined surgery for RP+POP and 204 women underwent surgery for POP only. Average age (59.3±1.0 vs 59.0±1.0) and parity (2.3 vs 2.6) was similar in each group. Average follow-up time was 307.2±31.5 days for the combined cohort and 487.7±49.9 days for the POP-only cohort. One hundred and nine patients (26.7%) had at least one 30-day complication. The proportion of patients who had a complication in the combined group and POP-only group was similar (27.0% vs 26.0%, p=0.82). CD scores were similar between the groups (10.3% vs 9.3% Grade 1, 11.8% vs 12.3% Grade 2, 3.9% vs 4.4% Grade 3, 1.0% vs 0% Grade 4, 0.5% vs 0% Grade 5). Combined patients were less likely than POP-only patients to develop postop UTIs and urinary retention, but were more likely to be treated for wound infections and pelvic abscesses. After adjusting for combined vs POP-only surgery, patients who had anti-incontinence procedures (aOR=1.85, 95% CI 1.16, 2.94, p=0.02) and perineorrhaphies (aOR=1.68, 95% CI 1.05, 2.70, p=0.02) were more likely to have <30-day postoperative complications. Twelve patients in the combined group and 15 patients in the POP-only group (5.9% vs 7.4%, p=0.26) had subsequent POP repair. Twenty-one patients in the combined surgery and 28 patients in the POP-only group (10.3% vs 13.7%, p=0.26) reported recurrent POP. On multivariable analysis adjusted for number of prior POP repairs, combined vs POP-only group and perineorrhaphy at the time of surgery, patients were more likely to have a subsequent POP surgery if they had had 2 or more prior POP repairs (aOR=6.06, 95% CI 2.10, 17.5, p=0.01). In this case-control study, patients undergoing combined POP+PR surgery had a similar risk of <30-day complications compared to patients undergoing POP-surgery alone. Combined patients also had a similar risk of recurrent POP and subsequent POP surgery compared to patients undergoing POP-only surgery.