Chronic Anticoagulation Increases Complications in Obliterative Prolapse Surgery.

IMPORTANCE: Chronic anticoagulation has been identified as a risk factor for postoperative complications in other specialties, but there is a paucity of data on its effect on older women undergoing obliterative prolapse repair. OBJECTIVE: The objective of this study was to assess whether chronic anticoagulation is associated with increased serious adverse events (SAEs) after obliterative prolapse surgery. STUDY DESIGN: This was a retrospective cohort analysis of women 65 years or older undergoing obliterative prolapse repair at 2 academic institutions from 2016 to 2023. Patients were identified by Current Procedural Terminology (CPT) code and grouped by preoperative chronic anticoagulation status. The composite primary outcome was defined as SAE within 8 weeks of surgery. Multivariable logistic regression was performed, controlling for relevant variables with P <0.10 on univariate analysis. RESULTS: Among the 777 older women who underwent obliterative surgery, 97 (12.5%) were chronically anticoagulated. The most commonly used anticoagulants were apixaban (n = 37, 38.1%) and clopidogrel (n = 31, 32%), with 21.7% reporting concomitant use of aspirin. Anticoagulated individuals were more likely to be current smokers and to have a history of venous thromboembolism, myocardial infarction, and stroke (P < 0.05). Chronically anticoagulated women had 1.72 times greater adjusted odds of experiencing SAE (95% CI, 1.02-2.91). Chronic anticoagulation was associated with an increased incidence of readmission, cardiac complications, transfusion, hematoma, and organ-space surgical site infection (P < 0.05). Rates of SAEs were highest in individuals taking rivaroxaban (35.7%) and those taking concomitant aspirin (38.1%). CONCLUSIONS: Chronic anticoagulation is associated with increased odds of SAE in older women undergoing obliterative prolapse surgery. Physicians should consider this additional risk in surgical decision making and counseling on anticoagulant suspension and resumption perioperatively.