Is There a Diminishing Benefit With Increasing Operative Time of Minimally Invasive Sacrocolpopexy? A Retrospective Analysis

Objective: To determine whether there is an operative time threshold beyond which minimally invasive sacrocolpopexy (MI-SCP) is less beneficial than abdominal sacrocolpopexy (ASCP).

Design: Retrospective analysis.

Setting: The National Surgical Quality Improvement Program (NSQIP) database.

Population: Patients undergoing MI-SCP or ASCP from 2011 to 2018.

Methods: Preoperative characteristics, operative variables and 30-day postoperative data were collected for each case. Groups were compared using the chi-squared or Kruskal-Wallis tests. Multivariable regression to identify risks of complications and prolonged hospital stay was performed using logistic and negative binomial models. Generalised additive models were applied to account for non-linear relationships between dependent and independent variables.

Main outcome measures: Occurrence of any major surgical complications and the length of stay.

Results: 13 678 sacrocolpopexies were performed, with the majority (78.6%) being MI-SCP. Although the groups were similar in age and BMI, those undergoing ASCP were more likely to have medical comorbidities. After adjusting for confounders, ASCP was not significantly associated with an increase in the probability of major complications compared to MI-SCP (aOR = 1.59, 95% CI: 0.99-2.54) and there was no significant interaction between procedure and operative time (aOR = 1.06, 95% CI: 0.94-1.20). ASCP was still associated with a prolonged LOS (aIRR = 2.19, 95% CI: 2.00-2.38). The interaction between procedure and operative time was significant (aIRR = 0.958, 95% CI: 0.93-0.98), but the LOS for MI-SCP never exceeded that of ASCP for operative times less than 6 h.

Conclusions: For surgeries lasting less than 6 h, MI-SCP is associated with similar morbidity and a shorter LOS when compared with ASCP.