Skip to main content

Advertisement

SpringerLink
Log in

Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patterns in the United States

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

A Commentary to this article was published on 15 June 2020

Abstract

Introduction and hypothesis

Support of the vaginal apex is paramount for a durable repair of pelvic organ prolapse (POP). Our aim is to assess national utilization of apical suspension procedures for the surgical treatment of complete POP. We hypothesize that there might be a high rate of apical suspension with advanced prolapse.

Methods

The 2006–2016 National Surgical Quality Improvement Program database was queried for a primary postoperative diagnosis of complete POP. The primary outcome was type of repair. Secondary outcomes included patient characteristics associated with apical suspension or colpocleisis. Procedures were delineated using CPT codes. Chi-squared and multivariate logistic regression analyses were used to evaluate factors associated with repair type.

Results

A total of 2,784 women underwent surgery for complete POP with a mean age of 64.6 ± 11.0 years. Overall, 1,300 (46.7%) patients underwent apical suspension: 487 sacrocolpopexies (17.5%), 428 extraperitoneal suspensions (15.4%), and 391 uterosacral suspensions (14.0%). 5.2% (144) underwent colpocleisis, and 47.5% (1,332) of women had a concurrent hysterectomy (CH). With CH, 38.6% (502) had apical suspension or colpocleisis versus 69.5% (940) of post-hysterectomy cases. On logistic regression, CH was inversely associated with apical suspension (adjusted odds ratio [aOR] 0.37, CI 0.32–0.44, p < 0.001). Colpocleisis was associated with older age (aOR 4.9 per 10 years, CI 3.8–6.3, p < 0.001), post-hysterectomy surgery (aOR 0.23, CI 0.1–0.4, p < 0.001 for CH), and higher comorbidity index (OR 1.7, CI 1.1–2.6, p = 0.009). Complication rates are similar with and without apical suspension (8.2% versus 7.0%, p = 0.269).

Conclusions

During surgery for complete POP, an apical suspension procedure is performed in 46.7% of patients and is more common post-hysterectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.

    Article  Google Scholar 

  2. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188(1):108–15.

    Article  Google Scholar 

  3. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.

    Article  Google Scholar 

  4. Committee on Practice Bulletins—Gynecology and the American Urogynecologic Society. Practice Bulletin No. 176: Pelvic Organ Prolapse. Obstet Gynecol 2017;129(4):e56–e72.

    Article  Google Scholar 

  5. Eilber KS, Alperin M, Khan A, Wu N, Pashos CL, Clemens JQ, et al. Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support. Obstet Gynecol. 2013;122(5):981–7.

    Article  Google Scholar 

  6. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.

    Article  Google Scholar 

  7. Fairchild PS, Kamdar NS, Berger MB, Morgan DM. Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse. Am J Obstet Gynecol. 2016;214(2):262.e1–7.

    Article  Google Scholar 

  8. Ross WT, Meister MR, Shepherd JP, Olsen MA, Lowder JL. Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate. Am J Obstet Gynecol. 2017;217(4):436.e1–8.

    Article  Google Scholar 

  9. Sheyn D, El-Nashar S, Mahajan ST, Mangel JM, Chapman GC, Hijaz AK. Apical suspension utilization at the time of vaginal hysterectomy for pelvic organ prolapse varies with surgeon specialty. Female Pelvic Med Reconstr Surg 2019;26(6):370–5.

    Article  Google Scholar 

  10. American College of Surgeons: About ACS NSQIP. Available at https://www.facs.org/quality-programs/acs-nsqip/about. Accessed 28 April 2016.

  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  Google Scholar 

  12. D'Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996;49(12):1429–33.

    Article  CAS  Google Scholar 

  13. Hill AM, Pauls RN, Crisp CC. Practice Patterns Regarding Apical Support Procedures at Time of Hysterectomy for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2019. https://doi.org/10.1097/SPV.0000000000000716

    Article  PubMed  Google Scholar 

  14. Adams-Piper ER, Guaderrama NM, Chen Q, Whitcomb EL. Impact of surgical training on the performance of proposed quality measures for hysterectomy for pelvic organ prolapse. Am J Obstet Gynecol. 2017;216(6):588.e1–5.

    Article  Google Scholar 

  15. Coolen AWM, Bui BN, Dietz V, Wang R, van Montfoort APA, Mol BWJ, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767–83.

    Article  Google Scholar 

  16. Linder BJ, El-Nashar SA, Mukwege AA, Weaver AL, McGree ME, Rhodes DJ, et al. Long-term outcomes and predictors of failure after surgery for stage IV apical pelvic organ prolapse. Int Urogynecol J. 2018;29(6):803–10.

    Article  Google Scholar 

  17. Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205(3):230.e1–5.

    Article  Google Scholar 

Download references

Funding

We had no extrainstitutional funding for this study.

Author information

Authors and Affiliations

  1. Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Emily A. Slopnick

  2. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA

    Emily A. Slopnick, Graham C. Chapman, Kasey Roberts & David D. Sheyn

  3. Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Graham C. Chapman, Kasey Roberts, Sherif El-Nashar & Sangeeta T. Mahajan

Authors
  1. Emily A. Slopnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Graham C. Chapman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kasey Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David D. Sheyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sherif El-Nashar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sangeeta T. Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

E.A. Slopnick: project development, data collection, management, analysis, manuscript writing; G. Chapman: data analysis, manuscript editing; K. Roberts: manuscript editing; D.D. Sheyn: data analysis, manuscript editing; S. El-Nashar: manuscript editing; S.T. Mahajan: project development, manuscript editing.

Corresponding author

Correspondence to Emily A. Slopnick.

Ethics declarations

Conflicts of interest

Dr. Sangeeta T. Mahajan is a member of the Astellas, Inc. Speaker’s Bureau. In addition, Dr. Mahajan receives grant funding from Allergan, Inc. We have no additional disclosures or conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Slopnick, E.A., Chapman, G.C., Roberts, K. et al. Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patterns in the United States. Int Urogynecol J 32, 791–797 (2021). https://doi.org/10.1007/s00192-020-04342-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-020-04342-0

Keywords

Search

Navigation