Incidence of Surgical Treatments After Obstetric Anal Sphincter Injury.

Abstract

Importance: Patients with obstetric anal sphincter injury (OASI) are at increased risk for postpartum complications.

Objective: To measure the incidence of surgical treatments within 1 year of delivery among patients with OASI. Secondary outcomes included identifying the indications for surgical retreatments of OASI complications and characterizing the procedures performed.

Study design: This was a retrospective cohort study of patients with OASI seen at a tertiary referral center between October 2017 and February 2023.

Results: A total of 623 patients sustained an OASI during the study period. The mean age was 30.9 years (SD 4.5). Most patients were White non-Hispanic (n = 454, 72.8%), with a mean body mass index (BMI) of 30.6 (SD 5.5). The mean gestational age at delivery was 39.1 weeks (SD 1.4). Nearly half underwent operative deliveries (n = 287, 46.1%), and the majority had a third degree OASI (n = 526, 84.4%). Thirteen patients (2.1%) underwent surgical treatment within 1 year of delivery. Fourteen total procedures were performed, as one patient required two surgeries. The most common indication for surgery was persistent pain or tenderness followed by dyspareunia, wound breakdown, rectovaginal fistula, and post-coital bleeding. The most frequently performed procedures included revision or excision of scar tissue, perineorrhaphy, excision of granulation tissue, revision of perineal wound disruption/breakdown, and transvaginal rectovaginal fistula repair. Urogynecologists performed 11 of the 14 procedures.

Conclusions: In this cohort, surgical intervention within 1 year of an OASI was uncommon. Postpartum patients with OASI should be screened for persistent pain and tenderness, dyspareunia, wound breakdown, rectovaginal fistula, and post-coital bleeding, as these symptoms may warrant surgical evaluation and treatment.