Shah YB, Capella CE, Simhal RK, D'Amico MJ, Smith W, Murphy AM
Abstract
Introduction: With the aging population, more females will suffer from pelvic organ prolapse. Both urologists and gynecologists perform sacrocolpopexy, but there is no comparative study analyzing differences in provision of care, outcomes, or patient population. We aimed to elucidate potential differences in demographics, outcomes, and minimally invasive surgery utilization for SCP performed by urology and gynecology. Methods: In our retrospective analysis, sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006-2020. Pearson's chi-square test was performed to test trends in the utilization of MIS in five-year blocks. Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index. Univariate analysis was performed using Student's t-test and Pearson's chi-square to compare operative parameters, frailty, demographics, and outcomes. Results: We identified 8944 sacrocolpopexies. Gynecology performed 81% of cases while urology performed the remaining 19% (p < 0.001). Between the specialties, there were no significant differences in outcomes, minor or major complications, or 30-day reoperations/hospital readmissions/mortality. However, urologists tended to care for patients who were older (65 vs. 61 years, p < 0.001) and frailer by both frailty indices (p < 0.001). Conclusion: Case distributions have remained stable, with gynecologists four-fold more sacrocolpopexies, in keeping with the larger number of practicing gynecologists vs. urologists. There was no difference in 30-day outcomes between both specialties. However, urologists operated on older, more frail patients.
