Following IRB approval, we collected data using the hospital's electronic medical records of all patients who underwent POP surgery with SSLF for apical suspension between January 2012 and December 2023. Data collected included comorbidities, body mass index (BMI), smoking status, menopausal status, parity, previous pelvic floor surgery, and pelvic floor symptom history. Prolapse staging was carried out using the pelvic organ prolapse quantification system (POP-Q). The surgeries were performed by a single fellowship-trained pelvic floor surgeon during January 2012- December 2018 (“Period 1”), by 2 fellowship-trained pelvic floor surgeons during January 2019-December 2020 (“Period 2”), and by the two senior surgeons and 3 fellows during January 2021- December 2023 (“Period 3”). Right SSLF was performed using either the Capio® device (Boston Scientific, Marlborough, MA, United States) with either 2 polyglactin-910 or 2 polypropylene sutures or the Digitex™ (Coloplast, Minneapolis, MN, United States) with 2 polydioxanone sutures. Concomitant procedures included vaginal hysterectomy, amputation of the uterine cervix, anterior and/or posterior colporrhaphy by native tissue repair. A trans-obturator mid-urethral sling (MUS) was carried out for overt or occult stress urinary incontinence (SUI). Data on duration of surgery, intraoperative estimated blood loss (EBL), visual analogue scale (VAS) pain levels on post-operative day 1 (POD-1) and at the 3-weeks follow-up, duration of hospital stay and perioperative complications were collected. For patients who returned for follow-up 6-18 months following surgery, data on subjective and objective outcome of surgery was collected.
Categorical variables were summarized as frequency and percentage. Continuous variables distribution was evaluated using histogram. Since all variables were not normally distributed, they were reported as median and IQR. Spearman’s correlation coefficient was used to evaluate the association between op time and years of experience. Chi-square test and Fisher exact test were applied to compare categorical variables between periods and Kruscal-Wallis test was used for continuous and ordinal variables. Multivariable logistic regression was used to study the association between period and postoperative pain, while controlling for potential confounders. The regression included 2 blocks. In the first block the period was forced into the regression. In the second block age, BMI, diabetes mellitus, asthma, anemia, smoking, constipation, sexual activity, previous POP surgery were considered for inclusion, using a forward stepwise method (p<0.05 was used as criteria for inclusion). All statistical tests were two-sided and p< 0.05 was considered significant. SPSS software was used for statistical analyses. (IBM SPSS statistics for Windows, Version 28, IBM corporation, Armonk, NY, USA, 2021).