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Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension.

Publication ,  Journal Article
Richter, HE; Sridhar, A; Nager, CW; Komesu, YM; Harvie, HS; Zyczynski, HM; Rardin, C; Visco, A; Mazloomdoost, D; Thomas, S ...
Published in: Am J Obstet Gynecol
January 2023

BACKGROUND: Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery in the Vaginal hysterectomy with Native Tissue Vault Suspension vs Sacrospinous Hysteropexy with Graft Suspension (Study for Uterine Prolapse Procedures Randomized Trial) trial, sacrospinous hysteropexy with graft (hysteropexy) resulted in a lower composite surgical failure rate than vaginal hysterectomy with uterosacral suspension over 5 years. OBJECTIVE: This study aimed to identify factors associated with the rate of surgical failure over 5 years among women undergoing sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral suspension for uterovaginal prolapse. STUDY DESIGN: This planned secondary analysis of a comparative effectiveness trial of 2 transvaginal apical suspensions (NCT01802281) defined surgical failure as either retreatment of prolapse, recurrence of prolapse beyond the hymen, or bothersome prolapse symptoms. Baseline clinical and sociodemographic factors for eligible participants receiving the randomized surgery (N=173) were compared across categories of failure (≤1 year, >1 year, and no failure) with rank-based tests. Factors with adequate prevalence and clinical relevance were assessed for minimally adjusted bivariate associations using piecewise exponential survival models adjusting for randomized apical repair and clinical site. The multivariable model included factors with bivariate P<.2, additional clinically important variables, apical repair, and clinical site. Backward selection determined final retained risk factors (P<.1) with statistical significance evaluated by Bonferroni correction (P<.005). Final factors were assessed for interaction with type of apical repair at P<.1. Association is presented by adjusted hazard ratios and further illustrated by categorization of risk factors. RESULTS: In the final multivariable model, body mass index (increase of 5 kg/m2: adjusted hazard ratio, 1.7; 95% confidence interval, 1.3-2.2; P<.001) and duration of prolapse symptoms (increase of 1 year: adjusted hazard ratio, 1.1; 95% confidence interval, 1.0-1.1; P<.005) were associated with composite surgical failure, where rates of failure were 2.9 and 1.8 times higher in women with obesity and women who are overweight than women who have normal weight and women who are underweight (95% confidence intervals, 1.5-5.8 and 0.9-3.5) and 3.0 times higher in women experiencing >5 years prolapse symptoms than women experiencing ≤5 years prolapse symptoms (95% confidence interval, 1.8-5.0). Sacrospinous hysteropexy with graft had a lower rate of failure than hysterectomy with uterosacral suspension (adjusted hazard ratio, 0.6; 95% confidence interval, 0.4-1.0; P=.05). The interaction between symptom duration and apical repair (P=.07) indicated that failure was less likely after hysteropexy than hysterectomy for those with ≤5 years symptom duration (adjusted hazard ratio, 0.5; 95% confidence interval, 0.2-0.9), but not for those with >5 years symptom duration (adjusted hazard ratio, 1.0; 95% confidence interval 0.5-2.1). CONCLUSION: Obesity and duration of prolapse symptoms have been determined as risk factors associated with surgical failure over 5 years from transvaginal prolapse repair, regardless of approach. Providers and patients should consider these modifiable risk factors when discussing treatment plans for bothersome prolapse.

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Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

January 2023

Volume

228

Issue

1

Start / End Page

63.e1 / 63.e16

Location

United States

Related Subject Headings

  • Uterine Prolapse
  • Treatment Outcome
  • Pelvic Organ Prolapse
  • Obstetrics & Reproductive Medicine
  • Obesity
  • Ligaments
  • Hysterectomy, Vaginal
  • Humans
  • Gynecologic Surgical Procedures
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Richter, H. E., Sridhar, A., Nager, C. W., Komesu, Y. M., Harvie, H. S., Zyczynski, H. M., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network, . (2023). Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension. Am J Obstet Gynecol, 228(1), 63.e1-63.e16. https://doi.org/10.1016/j.ajog.2022.07.048
Richter, Holly E., Amaanti Sridhar, Charles W. Nager, Yuko M. Komesu, Heidi S. Harvie, Halina M. Zyczynski, Charles Rardin, et al. “Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension.Am J Obstet Gynecol 228, no. 1 (January 2023): 63.e1-63.e16. https://doi.org/10.1016/j.ajog.2022.07.048.
Richter, Holly E., et al. “Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension.Am J Obstet Gynecol, vol. 228, no. 1, Jan. 2023, pp. 63.e1-63.e16. Pubmed, doi:10.1016/j.ajog.2022.07.048.
Richter HE, Sridhar A, Nager CW, Komesu YM, Harvie HS, Zyczynski HM, Rardin C, Visco A, Mazloomdoost D, Thomas S, Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension. Am J Obstet Gynecol. 2023 Jan;228(1):63.e1-63.e16.
Journal cover image

Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

January 2023

Volume

228

Issue

1

Start / End Page

63.e1 / 63.e16

Location

United States

Related Subject Headings

  • Uterine Prolapse
  • Treatment Outcome
  • Pelvic Organ Prolapse
  • Obstetrics & Reproductive Medicine
  • Obesity
  • Ligaments
  • Hysterectomy, Vaginal
  • Humans
  • Gynecologic Surgical Procedures
  • Female