Postoperative appointments: which ones count?

Authors:
Margaret G Mueller
Margaret G Mueller
Northwestern University Feinberg School of Medicine
Dana Elborno
Dana Elborno
Loyola University Chicago Stritch School of Medicine
Christina Lewicky-Gaupp
Christina Lewicky-Gaupp
University of Michigan Medical School
United States
Kimberly Kenton
Kimberly Kenton
Loyola University Medical Center
United States

Int Urogynecol J 2016 Dec 16;27(12):1873-1877. Epub 2016 Jun 16.

Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Introduction And Hypothesis: Although postoperative complications in women undergoing reconstructive pelvic surgery (RPS) have been characterized, little is known regarding the timeline of these occurrences. We aimed to determine the timeframe after RPS during which the majority of complications occur, to assist with planning intervals between postoperative visits.

Methods: Women undergoing RPS were identified through billing information. Demographic, surgical, and complications data were extracted from electronic medical records. The Pelvic Floor Complication scale is a surgical scale tailored to women undergoing RPS. It contains three subscales: intraoperative, immediately postoperative, and delayed complications. We applied this scale to each postoperative visit (at 2, 6, and 13 weeks).

Results: 396 women underwent RPS and 125 patients had 179 complications, most of which (66 %) were identified by the 2-week visit. Complications at the 2-week visit consisted of urinary tract infection (UTI; 46 %), wound infection (10.0 %), and urinary retention (9.4 %). The majority of serious complications (venous thromboembolism [VTE], ileus, small bowel obstruction [SBO], readmission, and reoperation [1 incarcerated hernia and 1 sling release]) were diagnosed by 2 weeks. One patient was readmitted for ileus at between 2 and 6 weeks. At between 6 and 13 weeks, 1 patient was readmitted with SBO; 1 VTE was diagnosed; and 1 required reoperation for a prolapsed fallopian tube. In contrast, two thirds of the complications seen at the 13-week visit were due to granulation tissue, suture erosion or mesh erosion.

Conclusions: The majority of non-mesh-related complications occur within the first 2 weeks after RPS, whereas mesh and suture complications are more likely to be identified at the 13-week visit.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-016-3052-2DOI Listing
December 2016
6 Reads

Publication Analysis

Top Keywords

women undergoing
12
complications
10
complications occur
8
2-week visit
8
patient readmitted
8
undergoing rps
8
13-week visit
8
rps
6
visit
5
postoperative
5
thromboembolism [vte]
4
visit 13 weeksresults
4
ileus 6 weeks
4
6 weeks 13 weeks
4
postoperative visit
4
scale postoperative
4
ileus small
4
13 weeksresults 396
4
396 women
4
venous thromboembolism
4

Similar Publications

Venous thromboembolism in reconstructive pelvic surgery.

Am J Obstet Gynecol 2014 Nov 25;211(5):552.e1-6. Epub 2014 Jul 25.

Division of Female Pelvic Medicine and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Objective: We sought to determine the incidence and risk factors for venous thromboembolism (VTE) in women undergoing reconstructive pelvic surgery (RPS).

Study Design: Using the American College of Surgeons National Surgical Quality Improvement Program registry, we identified patients who underwent RPS from 2006 through 2010 based on Current Procedural Terminology codes. We defined 2 cohorts: women with any RPS performed, with concomitant surgery from other specialties allowed (RPS + other), and women whose only procedure was RPS. Read More

View Article
November 2014

Risk factors for mesh erosion after vaginal sling procedures for urinary incontinence.

Eur J Obstet Gynecol Reprod Biol 2014 Jun 13;177:146-50. Epub 2014 Apr 13.

Department of Obstetrics and Gynaecology, Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey.

Objectives: To identify risk factors for mesh erosion in women undergoing vaginal sling procedures for urinary incontinence with synthetic meshes, and to estimate the incidence of mesh erosion after these procedures.

Study Design: Retrospective study of women who underwent vaginal sling procedures between January 2007 and January 2013. In total, 1439 consecutive women with stress urinary incontinence were investigated. Read More

View Article
June 2014

[Prospective study of the impact on lower urinary tract symptoms after pelvic organ prolapse surgery].

Zhonghua Fu Chan Ke Za Zhi 2011 Aug;46(8):570-3

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.

Objective: To investigate effect of urinary conditions and lower urinary tract symptoms (LUTS) in patients before and after the reconstructive pelvic surgery (RPS) for pelvic organ prolapse (POP) as well as effect of urinary conditions and LUTS by tension-free vaginal tape-obturator (TVT-O).

Methods: From Jan. 2007 to Dec. Read More

View Article
August 2011

[Study on mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapse].

Zhonghua Fu Chan Ke Za Zhi 2011 Feb;46(2):101-4

Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China. Email:

Objective: To evaluate clinical outcome and complications of mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapse.

Methods: From Feb 2007 to Jan 2009, mesh-augmented vaginal reconstructive surgery were performed on 66 women with pelvic organ prolapse stage III-IV. Pre and postoperative symptoms, pelvic organ prolapse quantitation (POP-Q) stage and pelvic floor distress inventory-short form 20 (PFDI-20) measurements were studied to assess anatomic and quality-of-life outcome. Read More

View Article
February 2011