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Apical Suspension Utilization at the Time of Vaginal Hysterectomy for Pelvic Organ Prolapse Varies With Surgeon Specialty

Sheyn, David, MD*†; El-Nashar, Sherif, MD*; Mahajan, Sangeeta T., MD*; Mangel, Jeffrey M., MD; Chapman, Graham C., MD*†; Hijaz, Adonis K., MD

Female Pelvic Medicine & Reconstructive Surgery: February 21, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000706
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Objective To evaluate whether utilization of apical suspension procedures at the time of vaginal hysterectomy for pelvic organ prolapse varies with surgeon specialty.

Methods This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2016. International Classification of Diseases, Ninth Revision, Clinical Modification with a diagnosis of pelvic organ prolapse who underwent vaginal hysterectomy with any combination of pelvic reconstructive procedures. Propensity score matching using available preoperative clinical data was used to ameliorate selection bias by specialty at a ratio of 1 female pelvic reconstructive surgeon (FPMRS) surgeon to 2 obstetrician-gynecologists (OBG). Descriptive statistics were reported as means with standard deviations. Pairwise analysis using Student t test and Fisher exact test was performed where appropriate.

Results After propensity score matching, there were 901 cases performed by FPMRS and 1802 performed by OBG. The overall utilization rate of apical suspension in the matched cohort was 81.7% for FPMRS and 19.8% for OBG (P < 0.001). Obstetrician-gynecologists were more likely to perform vaginal hysterectomy without apical suspension compared with FPMRS (44.3% vs 5.8%; P < 0.001) and were also more likely to perform nonapical vaginal repair without also performing an apical suspension, (17.7% vs 9.3%, P < 0.001), compared to urogynecologists. On multivariable logistic regression, having surgery performed by FPMRS was the only significant variable associated with an increased likelihood of undergoing apical suspension (adjusted odds ratio, 5.34; 95% confidence interval, 4.48–6.36).

Conclusions The FPMRS physicians are more likely to perform apical suspension with vaginal hysterectomy for prolapse repair compared with OBG.

From the *Division of Female PelvicMedicine andReconstructive Surgery, Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH; and

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH.

The authors have declared they have no conflicts of interest.

Correspondence: David Sheyn, MD, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH 44106. E-mail: david.sheyn@uhhospitals.org.

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