Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse

Abstract

Background It has been shown that addressing apical support at the time of hysterectomy for POP reduces recurrence and reoperation rates. In fact, national guidelines consider hysterectomy alone to be inadequate treatment for POP. Despite this, anterior and posterior colporrhaphy are frequently performed without a colpopexy procedure and hysterectomy alone is often utilized for treatment of prolapse. Objectives The objectives of this study were to: 1) determine rates of concomitant procedures for pelvic organ prolapse (POP) in hysterectomies performed with POP as an indication, 2) identify factors associated with performance of a colpopexy at the time of hysterectomy for POP, and 3) identify the influence of surgical complexity on perioperative complication rates. Study Design This is a retrospective cohort study of hysterectomies performed for POP from January 1, 2013 to May 7, 2014 in a statewide surgical quality database. Patients were stratified based on procedures performed: hysterectomy alone, hysterectomy with colporrhaphy and without apical suspension, and hysterectomy with colpopexy with or without colporrhaphy. Demographics, medical history and intraoperative care, and perioperative care were compared between the groups. Multivariable logistic regression models were created to identify factors independently associated with use of colpopexy and factors associated with increased rates of postoperative complications. Results POP was an indication in 1557 hysterectomies. Most hysterectomies were vaginal (59.6%), followed by laparoscopic or robotic (34.1%), and abdominal (6.2%). Hysterectomy alone was performed in 43.1% (95% CI 40.6–45.6) of cases, 32.8% (95% CI 30.4–35.1) had a colporrhaphy without colpopexy, and 24.1% (95% CI 22–26.3) had a colpopexy with or without colporrhaphy. Use of colpopexy was independently associated with patient age over 40, POP as the only indication for surgery (OR 1.6, 95% CI 1.185–2.230), laparoscopic surgery (OR 3.2, 95% CI 2.860–5.153), and a surgeon specializing in urogynecology (OR 8.2, 95% CI 5.156–12.923). The overall perioperative complication rate was 6.6%, with the majority being considered minor. Complications were more likely when the procedure was performed with an abdominal approach (OR 2.3, 95% CI 1.088–4.686), with the use of a colpopexy procedure (OR 3.1, 95% CI 1.840–5.194), and by a surgeon specializing in urogynecology (OR 2.2, 95% CI 1.144–4.315). Conclusions Colpopexy and colporrhaphy may be underutilized and are potential targets for quality improvement. Performance of additional procedures at the time of hysterectomy increased the rate of perioperative complications. Long-term consequences of these surgical practices deserve additional study.

Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate

“…5 Despite this, apical support procedures appear to be underutilized as shown in this and other studies. 5, 9, 20, 21 …”

The effect of diagnosis-related group payment system on the quality of medical care for pelvic organ prolapse in Korean tertiary hospitals

“…However, midurethral sling procedures require the use of an expensive surgical mesh, which cannot be reimbursed under the DRG system. Colpopexy can be performed with or without mesh, however, it requires a specialized surgical skill and is rarely performed by surgeons except for urogynecological subspecialists [17, 18]. Although there was a compensable increase in the rates of colporrhaphy after the introduction of DRG system, correction of anterior or posterior prolapse does not repair apical descent.…”

Various Approaches and Treatments for Pelvic Organ Prolapse in Women

“…It has been proven that the use of surgical mesh reduces hernia recurrence rate in comparison to hernia repair without surgical mesh 23. The mesh-related side-effects are erosion, infection and others, and removal of mesh is helpful in relieving symptoms of persistent pain, coital discomfort, severe vaginal discharge and others 24…”