Improving the accuracy of prolapse and incontinence procedure epidemiology by utilizing both inpatient and outpatient data

Abstract

Introduction and hypothesis

The epidemiologic description of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) procedures is documented in several large studies using national database cohorts. These studies, however, may underestimate the number of procedures performed because they only capture procedures performed in either the inpatient or outpatient settings alone. We present a complete annual description of all inpatient and outpatient surgeries for POP and SUI in California.

Methods

We reviewed a record of all inpatient and outpatient POP and SUI surgeries performed in California in 2008 using data from the Office of Statewide Health Planning (OSHPD).

Results

In 2008, 20,004 and 20,330 women in California underwent POP and SUI procedures, respectively. Of these, 3,134 (15.6 %) and 9,016 (44.3 %) were performed in an outpatient setting. The age-adjusted rates of POP and SUI were 1.20 and 1.20 per 1,000 US females, respectively. This correlates to 186,000 POP and 186,000 SUI procedures per year nationally. Vaginal apical suspensions were more common in those undergoing surgery as an inpatient (45.1 vs 19.4 %). The use of mesh to augment prolapse repairs was similar (22.3 % inpatient vs 19.3 % outpatient). SUI procedures performed in the outpatient setting were more likely to be performed as stand-alone procedures (82.9 vs 18.8 %, respectively).

Conclusions

In California, 16 % of POP and 44 % of SUI procedures were performed in an outpatient surgical setting in 2008. Epidemiologic studies of POP and SUI should account for the fact that a substantial number of repairs are performed in the outpatient setting in order to achieve accuracy.

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References

  1. 1.

    Erekson EA, Lopes VV, Raker CA et al (2010) Ambulatory procedures for female pelvic floor disorders in the United States. Am J Obstet Gynecol 203:497.e1–497.e5

    Article  Google Scholar 

  2. 2.

    Jones KA, Shepherd JP, Oliphant SS et al (2010) Trends in inpatient prolapse procedures in the United States, 1979–2006. Am J Obstet Gynecol 202:501.e1–501.e7

    Article  Google Scholar 

  3. 3.

    Shah AD, Kohli N, Rajan SS et al (2008) The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J Pelvic Floor Dysfunct 19:421–428

    PubMed  Article  Google Scholar 

  4. 4.

    Boyles SH, Weber AM, Meyn L (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188:108–115

    PubMed  Article  Google Scholar 

  5. 5.

    Brown JS, Waetjen LE, Subak LL et al (2002) Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol 186:712–716

    PubMed  Article  Google Scholar 

  6. 6.

    Wu JM, Gandhi MP, Shah AD et al (2011) Trends in inpatient urinary incontinence surgery in the USA, 1998–2007. Int Urogynecol J 22:1437–1443

    PubMed  Article  Google Scholar 

  7. 7.

    Oliphant SS, Wang L, Bunker CH et al (2009) Trends in stress urinary incontinence inpatient procedures in the United States, 1979–2004. Am J Obstet Gynecol 200:521.e1–521.e6

    Article  Google Scholar 

  8. 8.

    Boyles SH, Weber AM, Meyn L (2004) Ambulatory procedures for urinary incontinence in the United States, 1994–1996. Am J Obstet Gynecol 190:33–36

    PubMed  Article  Google Scholar 

  9. 9.

    Boyles SH, Weber AM, Meyn L (2003) Procedures for urinary incontinence in the United States, 1979–1997. Am J Obstet Gynecol 189:70–75

    PubMed  Article  Google Scholar 

  10. 10.

    Wu JM, Kawasaki A, Hundley AF et al (2011) Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 205:230.e1–230.e5

    Article  Google Scholar 

  11. 11.

    (2008) Patient discharge data file documentation. http://www.oshpd.ca.gov/HID/Products/PatDischargeData/PublicDataSet/Doc/PD08docwapp.pdf

  12. 12.

    (2008) Emergency department and ambulatory surgery center file documentation. http://www.oshpd.ca.gov/HID/Products/EmerDeptData/Documentation/EDAS_2008_1st.pdf

  13. 13.

    (2011) Table 2. Intercensal estimates of the resident population by sex and age for California: April 1, 2000 to July 1, 2010. http://www.census.gov/popest/data/intercensal/state/ST-EST00INT-02.html, vol. 2012

  14. 14.

    Klein RJ, Schoenborn CA (2001) Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes 20:1–10

  15. 15.

    (2011) Table 1. Intercensal estimates of the resident population by sex and age for the United States: April 1, 2000 to July 1, 2010. http://www.census.gov/popest/data/intercensal/national/nat2010.html, vol. 2012

  16. 16.

    ACOG Committee on Practice Bulletins–Gynecology (2007) ACOG Practice Bulletin No. 85: pelvic organ prolapse. Obstet Gynecol 110:717–729

    Article  Google Scholar 

  17. 17.

    Rhoads KF, Sokol ER (2011) Variation in the quality of surgical care for uterovaginal prolapse. Med Care 49:46–51

    PubMed  Article  Google Scholar 

  18. 18.

    Summers A, Winkel LA, Hussain HK et al (2006) The relationship between anterior and apical compartment support. Am J Obstet Gynecol 194:1438–1443

    PubMed  Article  Google Scholar 

  19. 19.

    Rooney K, Kenton K, Mueller ER et al (2006) Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 195:1837–1840

    PubMed  Article  Google Scholar 

  20. 20.

    Lowder JL, Park AJ, Ellison R et al (2008) The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse. Obstet Gynecol 111:152–157

    PubMed  Article  Google Scholar 

  21. 21.

    Elliott CS, Yeh J, Comiter CV et al (2013) The predictive value of a cystocele for concomitant vaginal apical prolapse. J Urol 189:200–203

    PubMed  Article  Google Scholar 

  22. 22.

    Rogo-Gupta L, Rodriguez LV, Litwin MS et al (2012) Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010. Obstet Gynecol 120:1105–1115

    PubMed  Google Scholar 

  23. 23.

    Iglesia CB, Sokol AI, Sokol ER et al (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116:293–303

    PubMed  Article  Google Scholar 

  24. 24.

    Paraiso MF, Barber MD, Muir TW et al (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195:1762–1771

    PubMed  Article  Google Scholar 

  25. 25.

    Milani R, Salvatore S, Soligo M et al (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG 112:107–111

    PubMed  Article  Google Scholar 

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Acknowledgments

Kim Rhoads’ work on this project was supported by a Harold Amos Medical Faculty Development Award from the Robert Wood Johnson Foundation, Princeton, NJ.

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Correspondence to Christopher S. Elliott.

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Elliott, C.S., Rhoads, K.F., Comiter, C.V. et al. Improving the accuracy of prolapse and incontinence procedure epidemiology by utilizing both inpatient and outpatient data. Int Urogynecol J 24, 1939–1946 (2013). https://doi.org/10.1007/s00192-013-2113-z

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Keywords

  • Pelvic organ prolapse
  • Stress urinary incontinence
  • Epidemiology
  • Surgery