Comparing Post-Operative Pain Outcomes in Pelvic Organ Prolapse Surgery With and Without a Hysterectomy.

Abstract

Introduction and hypothesis: Many surgeons perform hysterectomy at the time of pelvic organ prolapse (POP) surgery if the uterus is present, but it is unknown how this impacts patient pain. The objective of this study was to compare POP surgeries with and without a hysterectomy for differences in post-operative pain using a visual analog scale (VAS), and morphine milligram equivalents (MME) at 24 h.

Methods: This was a secondary analysis of a randomized controlled trial comparing the impact of pre-operative intravenous acetaminophen with placebo on post-operative pain following POP surgery.

Results: We included 202 subjects undergoing minimally invasive POP surgery. A concomitant hysterectomy was performed in 120 of the subjects (59.4%). Most were white (97.5%), had baseline POP-Q stage III prolapse (75%), and BMI 27.8 ± 4.3 kg/m², with no difference between groups. Those with concomitant hysterectomy were younger (64.2 ± 10.5 vs 67.5 ± 8.7 years, p = 0.02). Length of stay was 0.9 ± 0.5 days, and similar between groups (p = 0.24). Operative time was longer with concomitant hysterectomy (186.1 ± 52.7 vs 123.1 ± 47.2 min, p = 0.02). VAS scores 24 h post-operatively (hysterectomy = 3.0 ± 2.3, no hysterectomy = 2.7 ± 2.3, p = 0.49) and MMEs (51.4 ± 74.5 vs 37.1 ± 60.4, p = 0.15) were both similar. Patient-Reported Outcomes Measurement Information System scores measuring pain interference showed no difference between groups (22.9 ± 9.7 vs 20.9 ± 9.3, p = 0.21, possible range 8-40). Linear regression showed that concomitant hysterectomy did not impact 24-h VAS scores (adjusted beta = 0.113; p = 0.77) and showed no impact on 24-h MME (adjusted beta = 14.25; p = 0.15).

Conclusion: Although procedures were longer and patients were younger, with concomitant hysterectomy, there was no difference in 24-h VAS pain scores, 24-h MME opioid usage, or other pain metrics in POP surgeries with and without hysterectomy. Overall, opioid use and pain scores were low.