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Pelvic organ prolapse recurrence after apical prolapse repair: does obesity matter?

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A Commentary to this article was published on 28 May 2021

Abstract

Introduction and hypothesis

We hypothesized obesity increases the risk of pelvic organ prolapse recurrence (POP-R) after primary apical prolapse repair.

Methods

We conducted a retrospective cohort study of 353 women who underwent primary apical prolapse surgery from 2011 to 2016. Demographic and clinical data were abstracted from medical records. Multivariable Cox proportional hazard models were used to generate hazard ratios (HR) for association between obesity (BMI ≥ 30 kg/m2) and POP-R (leading edge > 0), adjusting for potential confounders. Given the potential for outcome ascertainment bias due to differential loss to follow-up, a sensitivity analysis was performed assuming all patients with < 6 months of follow-up developed POP-R.

Results

Ten percent of women developed POP-R. The median follow-up time was 7 months (range 1.4, 63.9). Twenty-four percent of patients were Black and 70% were White; 37% were obese. After controlling for confounders, obese women did not have an increased risk of POP-R (aHR 1.39; 95% CI 0.67, 2.86, p = 0.38). Although only marginally statistically significant, patients who developed POP-R were more likely to be current smokers (aHR 3.48, 95% CI 1.14, 10.67; p = 0.06) or previous smokers (aHR 1.86, 95% CI 0.82, 4.24, p = 0.06) in comparison to non-smokers. Sensitivity analysis showed loss to follow-up had the potential to influence our results.

Conclusions

Obesity was not a risk factor for POP-R in our cohort. Larger, prospective studies with longer postoperative follow-up time are needed to fully elucidate the relationship between obesity and POP-R.

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Acknowledgements

We would like to thank Dr. Alexcis Ford for her help with project development and Emilie Morris for her help with data collection.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Emory University School of Medicine, Emory Gyn/Ob Clinic, 1365 Clifton Road, Bldg A, 4th Floor, Attention Daphne Blow, Atlanta, GA, 30322, USA

    Nina Durchfort Metcalfe, Lisa M. Shandley, Marisa Rogers Young & Gina M. Northington

  2. Emory University School of Medicine, Atlanta, GA, USA

    Michelle Higgins

  3. Women’s Healthcare Associates, Portland, OR, USA

    Chidimma Abanulo

Authors
  1. Nina Durchfort Metcalfe
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  2. Lisa M. Shandley
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  3. Marisa Rogers Young
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  4. Michelle Higgins
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  5. Chidimma Abanulo
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  6. Gina M. Northington
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Contributions

ND Metcalfe: Protocol/project development, data collection/management, manuscript writing/editing.

LM Shandley: Protocol/project development, data analysis, manuscript editing.

M Young: Protocol/project development, manuscript editing.

M Higgins: Data collection/management, manuscript writing.

C Abanulo: Data collection/management.

GM Northington: Protocol/project development, manuscript editing, project mentor.

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Correspondence to Nina Durchfort Metcalfe.

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Metcalfe, N.D., Shandley, L.M., Young, M.R. et al. Pelvic organ prolapse recurrence after apical prolapse repair: does obesity matter?. Int Urogynecol J 33, 275–284 (2022). https://doi.org/10.1007/s00192-021-04806-x

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  • DOI: https://doi.org/10.1007/s00192-021-04806-x

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