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Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support

Eilber, Karyn S. MD; Alperin, Marianna MD; Khan, Aqsa MD; Wu, Ning PhD; Pashos, Chris L. PhD; Clemens, J. Quentin MD, MSCI; Anger, Jennifer T. MD, MPH

doi: 10.1097/AOG.0b013e3182a8a5e4
Pelvic Floor Disorders Research: Original Research
Journal Club

OBJECTIVE: Recurrent pelvic organ prolapse (POP) has been attributed to many factors, one of which is lack of vaginal apical support. To assess the role of vaginal apical support and POP, we analyzed a national dataset to compare long-term reoperation rates after prolapse surgery performed with and without apical support.

METHODS: Public use file data on a 5% random national sample of female Medicare beneficiaries were obtained from the Centers for Medicare and Medicaid Services. Women with POP who underwent surgery during 1999 were identified by relevant International Classification of Diseases, 9th Revision, Clinical Modification, and Current Procedural Terminology, Fourth Edition codes. Individual patients were followed-up through 2009. Prolapse repair was categorized as anterior, posterior, or anterior–posterior with or without a concomitant apical suspension procedure. The primary outcome was the rate of retreatment for POP.

RESULTS: In 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery that year. There were 2,756 women who underwent an anterior colporrhaphy, posterior colporrhaphy, or both with or without apical suspension. After 10 years, cumulative reoperation rates were highest among women who had an isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%; P<.01).

CONCLUSION: Ten years after surgery for POP, the reoperation rate was significantly reduced when a concomitant apical suspension procedure was performed. This analysis of a national cohort suggests that the appropriate use of a vaginal apical support procedure at the time of surgical treatment of POP might reduce the long-term risk of prolapse recurrence.

LEVEL OF EVIDENCE: II

The recurrence rate of vaginal prolapse is reduced by the addition of a vaginal apical support procedure at the time of initial prolapse surgery.

Division of Urology, Cedars-Sinai Medical Center Department of Surgery, and the Department of Urology, University of California, Los Angeles, Los Angeles, the Department of Reproductive Medicine, University of California, San Diego School of Medicine, San Diego, and United BioSource Corporation, San Francisco, California; and the Department of Urology, University of Michigan, Ann Arbor, Michigan.

Corresponding author: Jennifer T. Anger, MD, MPH, Associate Director of Urological Research, Cedars-Sinai Medical Center, 99 N. La Cienega Boulevard, #307, Beverly Hills, CA 90211; e-mail: Jennifer.Anger@cshs.org.

Funded by the NIDDK (1 K23 DK080227-05, JTA) and an American Recovery and Reinvestment Act (ARRA) Supplement.

Financial Disclosure Dr. Eilber is a speaker for Astellas, an investigator and consultant for American Medical Systems, and an investigator for Boston Scientific. Dr. Clemens is a consultant for Medtronic, Afferent Pharmaceuticals, and Amphora Medical. The other authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.