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The impact of subspecialty training on outcomes following surgery for pelvic organ prolapse – a NSQIP-based study

      Objectives

      To describe the impact of subspecialty training on outcomes following surgery for pelvic organ prolapse (POP).

      Materials and Methods

      Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we identified women undergoing POP surgery between 2014 and 2018 using Common Procedural Terminology codes. Patient and procedural characteristics, 30-day readmission, reoperation, and postoperative complications (POC) were collected. Patients whose surgery was performed by “Urogynecologists” (FPMRS) or “Obstetrician-Gynecologists” (OBG) were included in the study. The primary outcome was the presence or absence of a 30-day POC. Descriptive statistics were used to characterize the cohort, and pairwise analyses were performed to describe differences between cases performed by FPRMS vs OBG. Multivariable logistic regression was used to determine the impact of FPMRS training on 30-day POC while controlling for potential confounders.

      Results

      3,358 women underwent POP surgery—68% by FPMRS and 32% by OBG. Significant intergroup differences were noted across all surgical procedures. The 30-day POC rate was higher in the OBG group compared with FPMRS (7.0% vs 10.7%, P < 0.001). No differences were noted in readmissions (2.1% vs 2.0%, P=1.0); however, reoperations were higher in the OBG group (1.0% vs 1.8%, P=0.04). In a multivariable logistic regression model controlling for age, BMI, ASA class, smoking and types of surgeries, FPMRS training remained associated with a nearly 40% lower odds of any 30-day POC (aOR 0.62, 95% CI 0.48–0.80).

      Conclusion