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Patterns of Pessary Care and Outcomes for Medicare Beneficiaries With Pelvic Organ Prolapse

Alperin, Marianna MD, MS*; Khan, Aqsa MD; Dubina, Emily; Tarnay, Christopher MD; Wu, Ning PhD§; Pashos, Chris L. PhD§; Anger, Jennifer T. MD, MPH

Female Pelvic Medicine & Reconstructive Surgery: May/June 2013 - Volume 19 - Issue 3 - p 142–147
doi: 10.1097/SPV.0b013e31827e857c
Original Articles

Objectives: Using a national data set, we sought to assess patterns of pessary care in older women with pelvic organ prolapse (POP) and subsequent outcomes, including rates of complications and surgical treatment of POP.

Methods: Public use files from the US Centers for Medicare and Medicaid Services were obtained for a 5% random national sample of beneficiaries from 1999 to 2000. Diagnostic and procedural codes (International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology, 4th Edition) were used to identify women with POP and those treated with pessary. Individual subjects were followed longitudinally for 9 years. Across this duration, patient care and outcomes (eg, return clinic visits, repeated pessary placements, complications, and rate of surgical treatment of prolapse) were assessed.

Results: Of 34,782 women with a condition diagnosed as POP, 4019 women (11.6%) were treated with a pessary. In the initial 3 months after pessary placement, 40% underwent a follow-up visit with the provider who had placed the pessary, and through 9 years after the initial fitting, 69% had such a visit. During this period, 3% of the subjects developed vesicovaginal or rectovaginal fistulas, and 5% had a mechanical genitourinary device complication. Twelve percent of women underwent surgery for POP by 1 year; with 24% by 9 years.

Conclusions: Pessary can be effectively used for the management of POP in older women. Despite this, a low percentage of Medicare beneficiaries undergo pessary fitting. Lack of continuity of care is associated with a small but unacceptable rate of vaginal fistulas.

We assessed patterns of pessary care and outcomes for Medicare beneficiaries with pelvic organ prolapse.

From the *UCSD Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, San Diego; †UCLA Department of Urology, ‡UCLA Department of Obstetrics and Gynecology, Los Angeles, CA; §United BioSource Corporation, Lexington, MA; and ∥Division of Urology, Cedars-Sinai Medical Center Department of Surgery, Beverly Hills, CA.

Reprints: Jennifer T. Anger, MD, MPH, Cedars-Sinai Medical Center, 99 N La Cienega Blvd, No. 307, Beverly Hills, CA 90211. E-mail: angerj@cshs.org.

Funded by a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Patient-Oriented Research Career Development Award (1 K23 DK080227, to JTA) and an American Recovery and Reinvestment Act (ARRA) Supplement (5K23DK080227, to JTA).

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins