Healthcare Utilization After Minimally Invasive Sacrocolpopexy: Impact of Concomitant Rectopexy

Objectives: To compare unanticipated healthcare encounters following combined minimally invasive sacrocolpopexy and rectopexy (SCP+RP) versus sacrocolpopexy (SCP) alone.

Methods: This is a retrospective cohort study of women who underwent robotic/laparoscopic sacrocolpopexy from 2017-2020 at a tertiary referral center. Women were identified using CPT code 57425 and grouped based on performance of concomitant rectopexy. The primary outcome was rate of healthcare resource utilization (HRU) within 6 weeks after surgery. HRU was measured as a composite and included any unplanned outpatient visits excluding voiding trials, emergency room (ER) visits, or readmissions. HRU was compared between the SCP+RP and SCP groups.

Results: A total of 324 patients were included in the study: 81 SCP+RP and 243 SCP. The mean age of the cohort was 60.0 ± 11.8 years. Patient characteristics were similar between the groups with following exceptions: the SCP+RP group had lower BMI (26.3 ± 5.6 vs. 27.8 ± 5.1, p=0.033), were more likely to live >60 miles from the hospital (46.9% vs. 25.1%, p< 0.001), were more likely to have stage I apical prolapse (60.5% vs. 46.5%, p=0.004), and had increased length of hospital stay (1 [1, 1] day vs. 1 [0, 1] day, p< 0.001). Composite HRU rate was 18.2% (n=59/324) for the entire cohort and was significantly higher in the SCP+RP group than in the SCP group (25.9% vs. 15.6%, p=0.038). A higher proportion of SCP+RP patients had ≥1 ER visit (12.3% vs. 4.11%, p=0.009) and ≥1 readmission (7.4% vs. 1.6%, p=0.010) compared to SCP-only patients. Postoperative pain was the most common reason for an ER visit (n=3/81 in SCP+RP vs. n=4/243 in SCP, p=0.37), while bowel obstruction was the most common diagnosis for readmission (n=3/81 in SCP+RP vs. n=0/243 in SCP, p=0.015). Additionally, there were more postoperative phone calls made to the surgeon’s office in the SCP+RP group than in the SCP group (2 [0, 3] calls vs. 1 [0, 2] call, p=0.003). On multivariable regression analysis, postoperative urinary retention prior to discharge (aOR 2.119, 95% CI [1.096, 4.098]) and concomitant rectopexy at the time of sacrocolpopexy (aOR 2.510, 95% CI [1.304, 4.834]) were associated with increased likelihood of having at least one unanticipated healthcare encounter.

Conclusions: In this large cohort, nearly 1 in 5 women undergoing minimally invasive sacrocolpopexy had unanticipated healthcare encounters within 6 weeks after surgery. Concomitant rectopexy was associated with a 2.5-fold increase in odds of having at least one postoperative HRU encounter.