Surgical trends and patient factors associated with the treatment of apical pelvic organ prolapse from a national sample

Abstract

Introduction and hypothesis: Prolapse of the vaginal apex can be treated using multiple surgical modalities. We describe national trends and patient characteristics associated with the surgical approach and compare perioperative outcomes of abdominal versus vaginal repair of apical pelvic organ prolapse (POP).

Methods: The 2006-2012 National Surgical Quality Improvement Program Database was queried for abdominal sacrocolpopexy (ASC) and vaginal apical suspensions. Patients were stratified by whether or not concomitant hysterectomy (CH) was performed or whether or not they were post-hysterectomy (PH). Multivariate logistic regressions were adjusted for confounding variables.

Results: A total of 6,147 patients underwent apical POP repair: 33.9% (2,085) ASCs, 66.1% (4,062) vaginal suspensions. 60.0% (3,689) underwent CH. In all cohorts, older patients were less likely to have ASC (CH: OR 0.48, CI 0.28-0.83, p = 0.008 for age ≥ 60; PH: OR 0.28, CI 0.18-0.43, p < 0.001). Over time, the proportion of all vaginal and abdominal repairs remained relatively stable. Use of minimally invasive ASC, however, increased over the study period (trend p < 0.001), and use of mesh for vaginal suspensions decreased (p < 0.001). ASC had a longer median operative time (PH 174 vs 95 min, p < 0.001; CH 192 vs 127 min, p < 0.001). Complication rates were the same for vaginal repairs and ASC, overall and when sub-stratified by hysterectomy status.

Conclusions: Nationally, most apical POP repairs are performed via a vaginal route. Older age was predictive of the vaginal route for both CH and PH groups. ASCs had longer operative times. There has been increased utilization of minimally invasive ASC and decreased use of mesh-augmented vaginal suspensions over time.

Keywords: Gynecologic surgical procedures; Outcome assessment (health care); Pelvic organ prolapse; Urologic surgical procedures.