(Poster 04) Perioperative Outcomes After LeFort versus Total Colpectomy Colpocleisis

Objectives: Literature comparing these LeFort colpocleisis and total colpectomy colpocleisis is sparse. Our aim was to compare differences in perioperative outcomes of LeFort colpocleisis versus total colpectomy colpocleisis utilizing a large, national database.

Methods: This was a retrospective cohort study using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database to analyze perioperative outcomes of LeFort colpocleisis and total colpectomy colpocleisis. Women undergoing LeFort colpocleisis or total colpectomy colpcleisis for uterovaginal or vaginal vault prolapse were identified using Current Procedural Terminology codes. Our primary objective was to determine differences in perioperative complications between LeFort colpocleisis and total colpectomy colpocleisis. Our primary outcome was rate of postoperative complications within 30-days of surgery. Differences in demographics and clinical characteristics were analyzed as secondary objectives. Standard group comparisons were performed. Mann-Whitney U test was used for continuous variables and chi-square test for categorical variables.

Results: One thousand ninety seven women (N=1,097) were included. One thousand eighteen (87.1%) underwent a LeFort colpocleisis and 255 (12.9%) had a total colpectomy colpocleisis. Table 1 displays demographics, clinical characteristics, and perioperative outcomes within 30-days of surgery. Median (range) age of the entire cohort was 78 years (73-82) and body mass index (BMI) was 26.6 kg/m2 (23.7-29.5). Majority of women were White (69.4%) with American Society of Anesthesiology (ASA) functional class 2 or 3 (95.9%). Three hundred eighty five cases (19.5%) had a concomitant midurethral sling and 20 (1%) had a concomitant hysterectomy. Total colpectomy colpocleisis group had higher ASA class (p < 0.001) and were more likely to be Asian race (p < 0.001). Other demographics and clinical characteristics were similar between groups outside of race (p < 0.001) and ASA class (p < 0.03). Concomitant midurethral sling (38.4% versus 16.7%, p< 0.001) and hysterectomy (4.7% versus 0.5%, p< 0.001) were also more common at the time of total colpectomy colpocleisis. Median operative time was significantly longer for total colpectomy colpocleisis (101 minutes versus 92.5, p< 0.001). Overall rate of postoperative complications within 30-days of surgery was 3.7%. Postoperative complications were similar for LeFort colpocleisis (3.4%) and total colpectomy colpocleisis (5.5%, p=0.11). Readmission and reoperation rate for the entire cohort were 1.52% and 2.84% respectively, which were not significantly different between groups (p=0.79 and p=0.42).

Conclusions: Postoperative complications were overall low following obliterative surgery for pelvic organ prolapse. Perioperative complications, readmissions, and reoperations were similar between groups. LeFort colpocleisis was associated with an approximately 10 minute shorter operative time.