Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patter
- PDF / 244,707 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 46 Downloads / 191 Views
ORIGINAL ARTICLE
Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patterns in the United States Emily A. Slopnick 1,2 & Graham C. Chapman 2,3 & Kasey Roberts 2,3 & David D. Sheyn 2 & Sherif El-Nashar 3 & Sangeeta T. Mahajan 3 Received: 15 April 2020 / Accepted: 12 May 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Support of the vaginal apex is paramount for a durable repair of pelvic organ prolapse (POP). Our aim is to assess national utilization of apical suspension procedures for the surgical treatment of complete POP. We hypothesize that there might be a high rate of apical suspension with advanced prolapse. Methods The 2006–2016 National Surgical Quality Improvement Program database was queried for a primary postoperative diagnosis of complete POP. The primary outcome was type of repair. Secondary outcomes included patient characteristics associated with apical suspension or colpocleisis. Procedures were delineated using CPT codes. Chi-squared and multivariate logistic regression analyses were used to evaluate factors associated with repair type. Results A total of 2,784 women underwent surgery for complete POP with a mean age of 64.6 ± 11.0 years. Overall, 1,300 (46.7%) patients underwent apical suspension: 487 sacrocolpopexies (17.5%), 428 extraperitoneal suspensions (15.4%), and 391 uterosacral suspensions (14.0%). 5.2% (144) underwent colpocleisis, and 47.5% (1,332) of women had a concurrent hysterectomy (CH). With CH, 38.6% (502) had apical suspension or colpocleisis versus 69.5% (940) of post-hysterectomy cases. On logistic regression, CH was inversely associated with apical suspension (adjusted odds ratio [aOR] 0.37, CI 0.32–0.44, p < 0.001). Colpocleisis was associated with older age (aOR 4.9 per 10 years, CI 3.8–6.3, p < 0.001), post-hysterectomy surgery (aOR 0.23, CI 0.1–0.4, p < 0.001 for CH), and higher comorbidity index (OR 1.7, CI 1.1–2.6, p = 0.009). Complication rates are similar with and without apical suspension (8.2% versus 7.0%, p = 0.269). Conclusions During surgery for complete POP, an apical suspension procedure is performed in 46.7% of patients and is more common post-hysterectomy. Keywords Health services research . Pelvic organ prolapse . Reconstructive surgical procedures . Uterine prolapse
Introduction
This work was presented at the 49th International Continence Society Annual Meeting, 3–6 September 2019, Gothenburg, Sweden * Emily A. Slopnick [email protected] 1
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
2
Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
3
Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
Pelvic organ prolapse (POP) is a common women’s health concern that affects approximately 40% of women over the age of 50 [1]. By the age of 80 years, 12.6% of women will undergo surgery for prolapse, and appro
Data Loading...
