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The Surgical Approach to Abdominal Sacrocolpopexy and Concurrent Hysterectomy: Trends for the Past Decade

Objective The aim of the study was to understand the surgical trends and 30-day complications of patients undergoing an abdominal sacrocolpopexy with a concurrent hysterectomy. Methods This is a retrospective cohort study of surgical cases from the American College of Surgeons National Surgical Quality Improvement Program from 2010 to 2017 who underwent an abdominal sacrocolpopexy and a concurrent hysterectomy. Results There were 9327 surgical cases of an abdominal sacrocolpopexy with a concurrent hysterectomy of which 7772 (83.3%) were minimally invasive and 1555 (16.7%) were through a laparotomy. The proportion of patients undergoing a laparotomy decreased by 2.4% per year from 2010 to 2018 (R2 = 0.77). Among minimally invasive procedures, 4359 (46.7%) involved a concurrent supracervical hysterectomy and 4968 (53.3%) involved a concurrent total hysterectomy. Among minimally invasive procedures, patients who had a concurrent supracervical hysterectomy both had a longer operative time and were more likely to be admitted at least 2 days postoperatively compared with those who had a concurrent total hysterectomy (P < 0.001 for both). Conclusions Patients undergoing an abdominal sacrocolpopexy and concurrent hysterectomy are increasingly likely to undergo surgery in a minimally invasive approach. The Food and Drug Administration safety communication on electric power morcellation did not impact this trend. Although complication rates are low, regardless of the type of concurrent hysterectomy, some complications, such as blood transfusions and surgical site infections, seem to be highest for those undergoing a concurrent total hysterectomy despite the fact that a concurrent supracervical hysterectomy may be associated with a longer operative time and longer hospital admission.