Pelvic organ prolapse surgery after different hysterectomy methods: a population-based cohort study

Abstract

The US Census Bureau projects that the number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050 [1]. Considering yearly surgical costs in the US have been consistently greater than one billion USD since 1997, it is safe to project that the surgical healthcare expense for pelvic organ prolapse (POP) will be exponentially increased by 2050 [2]. Hysterectomy, among other factors, has been associated with an increased risk for subsequent POP [3][4][5][6][7]. Altman et al. studied the risk for POP surgery attributed to hysterectomy until the year 2003 [4]. However, since 2003, rapidly developing technology has created a shift towards laparoscopic and robotic techniques for uterine removal as opposed to the open laparotomy method [8, 9].Although the benefits of laparoscopic/robotic modalities are well known, their association with future risk for prolapse, compared to vaginal or open abdominal hysterectomy, remains unclear. The present authors utilized a large-scale patient population to examine the association of future prolapse repair with different types of hysterectomy.The aim of this study was to estimate the incidence of POP surgery after abdominal hysterectomies compared to laparoscopic/robotic-assisted, vaginal, and supracervical hysterectomies for benign cases in the US. Materials and MethodsThe present authors conducted a retrospective cohort study using health insurance claims from the Clinformatics Data Mart (CDM) Database. This de-identified database contains insurance claims for medical services and drug prescriptions for over 56 million enrollees in the US. This study was determined to be exempt by the institutional review board of the University of Texas Medical Branch at Galveston.The study cohort consisted of women aged 18-64 who received hysterectomies between January 2005 and September 2014 (Table 1) with any of the following modalities: robotic or laparoscopic, supracervical, open abdominal, or vaginal procedures (Table 2). The authors included women who had continuous insurance enrollment 12 months before and three months after the hysterectomies (Figure 1). The authors excluded women with prolapse procedure or diagnosis (Table 3) in the 12 months prior to hysterectomy because they are more likely to have a prolapse compared to those without history regardless of the hysterectomy modality. The authors also excluded any concomitant prolapse procedures or diagnoses, as well as prolapse procedures or diagnoses in the immediate three months following hysterectomy (Figure 1). That is, the authors excluded POP that was not identified

The Carolina hysterectomy cohort (CHC): a novel case series of reproductive-aged hysterectomy patients across 10 hospitals in the US south

“…Hysterectomies are often performed for benign gynecologic conditions such as fibroids, endometriosis, pelvic pain, and uterine prolapse [5]. After cesarean sections, hysterectomies are the second most common surgery performed on US women under age 65 with one-third receiving hysterectomy before age 60 [6].While the surgery can be an effective treatment for debilitating gynecologic conditions and lowers endometrial cancer risk, there are severe, irreversible consequences such as infertility, surgical complications, and increased stroke and mortality risks to consider especially when operating for benign gynecological conditions [7][8][9][10].…”