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Role of concurrent vaginal hysterectomy in the outcomes of mesh-based vaginal pelvic organ prolapse surgery

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Abstract

Introduction and hypothesis

Hysterectomy is often performed at the time of pelvic organ prolapse (POP) surgery; yet, there is insufficient evidence regarding the specific effect of hysterectomy on outcomes. We sought to determine the outcomes and associated short-term complications of mesh-based POP surgery with and without concurrent hysterectomy.

Methods

We utilized the New York Statewide Planning and Research Cooperation System (SPARCS) database to identify patients under 55 years of age undergoing surgeries for POP with mesh between 2009 and 2014. Patients who had a hysterectomy at the time of mesh-based POP surgery were compared with those who underwent mesh-based POP surgery without hysterectomy. Outcome measures of the patient groups before and after propensity score matching were compared. We assessed the difference Chi-squared tests and log-rank tests in the entire cohort and Mantel–Haenszel stratified Chi-squared tests and Prentice-Wilcoxon tests in the matched cohort.

Results

A total of 1,601 women underwent mesh-based POP surgery. 921 patients underwent concurrent hysterectomy, whereas 680 had mesh-based uterine-preserving POP surgery. After propensity score matching, there was no difference in reintervention rates between groups for up to 3 years. Concurrent hysterectomy with mesh-based POP repair was consistently associated with longer hospitalization (20.0% vs 12.8% stayed longer than 2 days) and higher charges (median charges were $22,689 vs $19,273).

Conclusions

Concurrent hysterectomy during mesh-based POP surgery in patients under 55 years led to more expensive charges and a longer stay compared with uterine-preserving mesh surgery. There was no difference in reintervention rates between groups for up to 3 years.

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Author information

Authors and Affiliations

  1. Beaumont Hospital, Dublin, Ireland, D09 V2N0

    James C. Forde

  2. Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA

    Bilal Chughtai

  3. Department of Urologic Reconstruction, Urodynamics, and Female Urology, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Jennifer T. Anger

  4. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA

    Jialin Mao & Art Sedrakyan

Authors
  1. James C. Forde
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  2. Bilal Chughtai
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  3. Jennifer T. Anger
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  4. Jialin Mao
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  5. Art Sedrakyan
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Corresponding author

Correspondence to Bilal Chughtai.

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Conflicts of interest

J.A. declares that she is an investigator and expert witness for Boston Scientific Corporation.

Additional information

James C. Forde and Bilal Chughtai are co-first authors

Appendix

Appendix

Table 4 Definition for procedures
Full size table
Table 5 Definition for complications
Full size table
Table 6 Demographics and comorbidities of patients undergoing mesh-based POP surgery with hysterectomy or uterine-preserving surgery between 2009 and 2014 in New York state
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Forde, J.C., Chughtai, B., Anger, J.T. et al. Role of concurrent vaginal hysterectomy in the outcomes of mesh-based vaginal pelvic organ prolapse surgery. Int Urogynecol J 28, 1183–1195 (2017). https://doi.org/10.1007/s00192-016-3244-9

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  • DOI: https://doi.org/10.1007/s00192-016-3244-9

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