Before a patient undergoes pelvic reconstructive surgery, the risk of potential complications should be carefully assessed and addressed with the patient. Complications may occur during or after the procedure, and it is imperative to recognize high-risk patients and minimize the risk from surgery before a patient is brought to the operating room. The lifetime risk of a woman undergoing prolapse or incontinence surgery is 19% (Smith FJ, Holman CD, Moorin RE, Tsokos N. Obstet Gynecol. 116(5):1096–1100, 2010; Maher C, Feiner B, Baessler K, Schmid C. Cochrane Database Syst Rev. 4:CD004014, 2013). The prevalence of perioperative complications among women undergoing reconstructive pelvic surgery has been reported to be as high as 33% (Lambrou NC, Buller JL, Thompson JR, Cundiff GW, Chou B, Montz FJ. Am J Obstet Gynecol. 183:1355–60, 2000). There are a multitude of factors that are found to increase perioperative risk. A large retrospective cohort study including 1,931 women who had undergone prolapse surgery found an overall complication rate of 14.9% (Handa VL, Harvey L, Cundiff GW, Kjerulff KH. Adult Urol. 65:483–7, 2004). The complications identified included infection, bleeding, surgical injuries, pulmonary, and cardiovascular morbidity. These complications were associated with medical comorbidities (odds ratio 11.2) and concomitant hysterectomy (odds ratio 1.5). Risk factors for complications after pelvic reconstructive surgery are listed in Table 4.1.