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Perioperative complications after reconstructive surgery for pelvic organ prolapse in patients with diabetes: analysis of a national database

      Objectives

      The aim of this study was to evaluate the effect of diabetes subtypes (insulin-dependent versus non-insulin dependent) on rates of 30-day postoperative wound and overall complications following reconstructive surgery for pelvic organ prolapse.

      Materials and Methods

      This is a retrospective cohort analysis of the National Surgical Quality Improvement Program (NSQIP) using data collected between 2011 and 2019. We selected patients using current procedural terminology codes for pelvic organ prolapse repair. Cases were excluded for and pre-existing malignancy, sepsis and wound infection. We defined three cohorts by diabetes status: no diabetes (NDM), non-insulin dependent diabetes (NIDDM), and insulin-dependent diabetes (IDDM). Procedures were grouped by main approach: vaginal, abdominal or laparoscopic. Complication rates were compared between the three cohorts and surgical approaches. Complications were categorized as wound complications (superficial, deep and organ space surgical site infections, and wound disruptions), other infectious complications (UTI, sepsis, septic shock, and pneumonia), pulmonary/vascular complications and cardiovascular complications. Readmission and reoperation rates were also assessed. Multivariable logistic regression analyses were performed to elucidate additional risk factors associated with post-operative complications.

      Results

      We identified 57,848 patients. The majority were white (90%), non-smokers (90%) with a median age of 61 years old and BMI of 27.6 kg/m2. Most prolapse repairs were done by vaginal approach (87%). The rates of wound complications, pulmonary, cardiovascular complications, and composite of all complications were significantly higher in the IDDM group compared to the NDM and NIDDM groups (wound: 2.2% vs. [1.3% and 1.2%]; pulmonary/cardiovascular: 2.7% vs. [1.2% and 1.5%]; composite: 10.0 % vs. [6.4% and 7.0%], p<0.017 on all post hoc analyses). In particular, the rates of organ space infections (OSSI) and myocardial infarctions (MI) were higher in the IDDM group compared to NDM and NIDDM groups (OSSI: 0.9% vs. 0.4% and 0.4%, p = 0.03; MI: 0.4%, 0.1% and 0.2%, p = 0.0006). There were no differences in other infectious complications. Surgical route did not significantly affect complication rates. The rate of readmission for the IDDM cohort was 4.6% vs. 2.3% and 2.5% for the NDM and NIDDM groups respectively (p<0.0001). On multivariable regression analysis of composite overall complications and wound complications, diabetes was not significantly associated with higher complication rates (p = 0.10).

      Conclusion

      Although there was a higher rate of complications and readmissions in the IDDM group, regression analysis revealed that these differences were not statistically significant when adjusting for demographic and clinical factors.