Practice pattern variation: treatment of pelvic organ prolapse in The Netherlands

Abstract

Introduction and hypothesis Great variety in clinical management of pelvic organ prolapse (POP) has been described over the last years. Practice pattern variation (PPV) reflects differences in care that cannot be explained by the underlying condition. We aim to explore whether PPV in management of POP in The Netherlands has changed between 2011 and 2017. Methods We conducted a multicenter cohort study, using prospective routinely collected benchmark data from LOGEX, a healthcare analytics company (Amsterdam, The Netherlands). Data of patients with a diagnosis POP from 50 hospitals (16 teaching and 34 non-teaching hospitals) were collected for the years 2011 and 2017. All treatments were categorized into three groups: conservative treatment, uterus-preserving or uterus-removing surgery. Using meta-analysis, we evaluated whether the proportions of conducted treatments changed over time and estimated the between-center variation (Cochran’s Q), reflecting the PPV in 2011 and 2017. This variation was analyzed using F-tests. Results Compared to 2011, referral for POP in 2017 decreased by 16.2% (−4505 patients), and the percentage of hysterectomies decreased by 33.6% (p < 0.0001). The PPV of POP surgery decreased significantly by 47.2% (p = 0.0137) and of hysterectomies by 41.5% (p = 0.0316). Conclusions We found a decline in PPV for POP surgery between 2011 and 2017. Furthermore, the number of surgical interventions decreased, which was mostly due to a decline of hysterectomies. This indicates a shift toward more conservative therapy and uterus preservation. A further reduction of PPV would be beneficial for the quality of health care.

Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data

“…Like hysterectomy, POP surgery is a variation-prone kind of surgery, with potential risks of inappropriate under-treatment/over-treatment 20. Several studies on practice variation are available 20 21. However, poor evidence is available regarding POP surgery in Italy.…”

Patient's preference for sacrospinous hysteropexy or modified Manchester operation: A discrete choice experiment

“…[7][8][9][10] This rise of alternative treatment options without clear conclusions about which operation has the best result has led to 'practice pattern variation'. 11 A few studies have been carried out to clarify patients' preference for VH or uterus preservation in the treatment of uterine prolapse. These studies have shown preference for uterus preservation in the absence of substantial benefit over VH.…”

“… 7 , 8 , 9 , 10 This rise of alternative treatment options without clear conclusions about which operation has the best result has led to ‘practice pattern variation’. 11 …”

“…Several studies investigated the surgical outcomes after the different types of surgery and concluded that compared with VH, MM and SH have similar or possibly even better outcomes 7–10 . This rise of alternative treatment options without clear conclusions about which operation has the best result has led to ‘practice pattern variation’ 11 …”

Manchester Procedure vs Sacrospinous Hysteropexy for Treatment of Uterine Descent

“…4 The most commonly performed procedure worldwide includes removal of the uterus and suspension of the upper vagina, 2,3 although there are geographic variations in surgical preferences. [4][5][6] In the last decade, surgical techniques that preserve the uterus are becoming more common. 5,7 The current practice in the Netherlands for all stages of uterine prolapse is uterussparing surgery, and a slight majority (60%) of gynecologists prefers sacrospinous hysteropexy over the Manchester procedure as first choice of procedure in the primary treatment of uterine descent.…”