Shifts in national rates of inpatient prolapse surgery emphasize current coding inadequacies.
ABSTRACT : This study aimed to assess national rates, types, and routes of inpatient surgery for pelvic organ prolapse in the United States in 1998 compared to those in 2007.
: We used the 1998 and 2007 Nationwide Inpatient Sample, which represents a stratified, random sample of discharge data from US hospitals. We included women 20 years and older who underwent surgery for prolapse based on diagnosis and procedure codes of the International Classification of Disease, 9th Revision, Clinical Modification. We calculated the number of women undergoing surgery each year and incidence rates.
: The total number of women undergoing prolapse surgeries was 92,503 in 1998 versus 113,646 in 2007. The incidence rate of surgery increased slightly, from 90.8 to 100.9 per 100,000 women, respectively. The most common procedure was hysterectomy, representing approximately half of prolapse surgeries in 1998 and 2007. Suspension procedures accounted for 18.8% of procedures in 2007, an increase from 6.1% in 1998. Surgeries performed via a minimally invasive route increased from 4.8% in 1998 to 9.4% in 2007. However, it was difficult to determine the route for many procedures based on current ICD-9 codes. There were also no codes that specifically designated mesh kit procedures or minimally invasive sacrocolpopexies.
: During the last decade, the rate of inpatient prolapse surgery has slightly increased. The proportion of suspension procedures has increased; however, it is difficult to determine the route of these procedures based on current ICD-9 codes. These findings emphasize that ICD-9 procedure codes have not kept up with changes in clinical practice.
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ABSTRACT: Pelvic organ prolapse (POP) surgery has lately gained importance in gynecological practice. This study aims to characterize the evolution of POP surgical procedures conducted in Portugal in the last decade and the impact of an FDA 2011 safety communication on mesh POP surgeries. Trends in the surgical management of POP were assessed using the Portuguese National Medical Registry. We considered all records of women with diagnosis of genital prolapse from 1 January 2000 to 31 December 2012. Additionally, we also conducted a survey among members of the Portuguese Society of Urogynecology to evaluate current practices in the surgical management of POP. From 2000 to 2012, 46,819 diagnoses of genital prolapse were registered, with a 105 % increase during the study period (2,368 in 2000 to 4,941 in 2012). POP mesh surgery represented only 6 % of total prolapse diagnoses, but mesh use greatly increased up to 2011, when only a slight increase was registered. Among gynecologists who responded to the questionnaire, there was considerable variability on the procedures of choice to treat POP. Fifty-seven per cent of respondents performed vaginal mesh POP surgery, but only 27 % of those actually reported having changed their practice after the FDA 2011 safety communication. Surgical procedures for POP conducted in Portugal greatly increased over the last decade. The use of surgical meshes is still limited, but despite FDA safety communication it has increased over the years, with a slight increase in 2012, which illustrates the need for further analyses in the coming years.International Urogynecology Journal 08/2014; 26(1). DOI:10.1007/s00192-014-2480-0 · 2.16 Impact Factor
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ABSTRACT: Delivery of care for disorders of the female pelvic floor has changed significantly over the past two decades as the prevalence of the urinary incontinence and pelvic prolapse has increased and many new surgical techniques and devices have become available to the pelvic surgeon. The trend for surgical management of both stress incontinence and prolapse has been toward less invasive and morbid procedures that can be performed in outpatient settings. Unfortunately, early adoption of new technology can outpace clinical evidence for the efficacy and safety of certain devices. Recent actions by the US Food and Drug Administration regarding synthetic pelvic mesh reflect some of the controversy surrounding these newer technologies and highlight some of the major trends in patterns of care delivery.Current Bladder Dysfunction Reports 09/2012; 7(3). DOI:10.1007/s11884-012-0137-8
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ABSTRACT: Study Objective To compare the change from pre- to post-operative total vaginal length (TVL) in women who underwent either a vaginal hysterectomy (TVH) with uterosacral ligament suspension (USLS) or a robotic hysterectomy (RH) with colpopexy (SCP). Secondary objectives included comparing sexual function, pelvic floor function, and prolapse recurrence between routes of surgery. Design This was a retrospective cohort study. Design Classification: II-2 Setting This was conducted at one tertiary academic medical center over a two-year period. Patients Women who underwent either TVH/USLS or RH/SCP Interventions Baseline and postoperative POP-Q exams were recorded as well as postoperative validated questionnaires. Twenty-nine subjects were needed in each group to detect a 1.5 cm difference in TVL. Measurements and Main Results There were 38 TVH/USLS and 46 RH/SCP participants. Robotic hysterectomies were either total 28/46 (61%) or supracervical 18/46 (39%). Mean postoperative follow-up was 9.5+3.1 months. For the primary outcome, women in the TVH/USLS group had a decrease in TVL whereas women in the RH/SCP group had an increase in TVL (-0.6 ± 1.0 cm vs. +0.5 ± 0.8 cm, p<.001). Among sexually active women (55/84, 65.5%) there was no difference in postoperative sexual function between groups, based on PISQ-12 scores, with good sexual function in both groups (32.6 ± 6.2 TVH/USLS vs. 35.1 ± 7.3 RH/SCP, p=.22). While both groups demonstrated good postoperative apical support, the TVH/USLS group had a slightly lower mean C point compared to the RH/SCP group (-6.8 ± 1.2 vs. -7.7 ± 1.8, p = .02). Both groups demonstrated good postoperative pelvic floor function, with no difference in mean postoperative PFDI scores (42.2 ± 45.4 vs. 52.7 ± 46.6, p=.44). Recurrent prolapse (defined as any prolapse at or beyond the hymen) was not different between groups: 13.2% for TVH/ USLS vs 6.5% for RH/SCP (p=.46). Conclusions Vaginal length decreased after vaginal hysterectomy with pelvic support surgery as compared to robotic hysterectomy with pelvic support surgery, with no differences in postoperative sexual function or pelvic floor function between groups.Journal of Minimally Invasive Gynecology 11/2014; 21(6). DOI:10.1016/j.jmig.2014.04.011 · 1.58 Impact Factor