Impact of Abnormal Preoperative Labs on Perioperative Outcomes After Prolapse Surgery

INTRODUCTION: While preoperative lab testing is performed to identify patients at risk for adverse perioperative events, there are limited data to guide surgeons prior to reconstructive pelvic surgery. OBJECTIVE: To identify the impact of abnormal preoperative lab results on perioperative outcomes after prolapse surgery using a large, national database. METHODS: This is a retrospective cohort study utilizing the 2014 to 2023 American College of Surgeons National Surgical Quality Improvement Program database to assess the impact of abnormal preoperative labs on perioperative outcomes after prolapse surgery. Women undergoing prolapse surgery were identified using CPT codes. Preoperative labs included hemoglobin, hematocrit, platelet count, serum creatinine, partial thromboplastin time (PTT), international normalized ratio (INR), and serum sodium. Hemoglobin 1.0 mg/dL, PTT >36 seconds, INR >1.2, and sodium <135 mEq/L were a priori categorized as clinically meaningful lab abnormalities. Prolapse cases were categorized into major and minor surgeries. Major surgeries included minimally invasive sacrocolpopexy, sacrospinous ligament suspension, uterosacral ligament suspension, colpocleisis, and vaginal mesh. Anterior and/or posterior colporrhaphy and paravaginal repair were categorized as minor surgeries. The primary objective was to determine the impact of abnormal preoperative labs on the rate of 30-day postoperative complications. Additional factors associated with abnormal preoperative labs were analyzed as secondary objectives. Standard group comparisons were performed for continuous and categorical variables. A multivariable logistic regression was completed to determine if abnormal preoperative labs impacted the rate of postoperative complications. Backwards selection was used to identify variables. Variables with a p<0.10 on bivariate analysis were included. RESULTS: A total of 42,250 patients had prolapse surgery: 15,760 (37.3%) had abnormal preoperative labs and 26,490 (62.4%) had normal preoperative labs (Table 1). Women with normal preoperative labs had a higher body mass index (BMI) (28.1 kg/m2 vs 24.5, p<0.001). Women with abnormal labs had higher American Society of Anesthesiologists (ASA) functional status (31.6% vs 30.3%, p<0.001) and less medical comorbidities (49.8% vs 52.0%, p<0.001). Surgical procedures differed by group as women with normal labs were more likely to have a concomitant sling (26.1% vs 23.8%, p<0.001) and laparoscopic route for hysterectomy (8.4% vs 6.8%, p<0.001); although women with abnormal labs were more likely to undergo a major prolapse surgery (63.6% vs 61.3%, p<0.001). Median operative time was longer in the normal preoperative lab cohort (96 minutes vs 90, p<0.001). The overall postoperative complication rate was 6.1% and significantly different between the two groups. Women with abnormal preoperative labs had a postoperative complication rate of 6.5% compared to 5.9% in women with normal labs (p=0.01). On regression analysis, women with abnormal preoperative labs had higher odds of postoperative complications compared to women with normal preoperative labs (aOR 1.14, 95% CI 1.05–1.23). CONCLUSIONS: Abnormal preoperative laboratory values were associated with a modest but significant rise in postoperative complications, highlighting their role as a marker of surgical risk in women undergoing prolapse repair. Optimizing outcomes requires that preoperative laboratory testing be guided by each woman’s unique risk factors and comorbidities rather than applied uniformly.Table 1Table 2