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Comparative outcomes of open versus laparoscopic sacrocolpopexy among medicare beneficiaries

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Abstract

Introduction and hypothesis

Since the first reported laparoscopic sacrocolpopexy in 1991, a limited number of single-center studies have attempted to assess the procedure’s effectiveness and safety. Therefore, we analyzed a national Medicare database to compare real-world short-term outcomes of open and laparoscopically assisted (including robotic) sacrocolpopexy in a United States sample of patients.

Methods

Public Use File data for a 5 % random national sample of all Medicare beneficiaries aged 65 and older were obtained from the Centers for Medicare and Medicaid Services for the years 2004–2008. Women with pelvic organ prolapse were identified using ICD-9 diagnosis codes. CPT-4 procedure codes were used to identify women who underwent open (code 57280) or laparoscopic (code 57425) sacrocolpopexy. Individual subjects were followed for 1 year post-operatively. Outcomes measured, using ICD-9 and CPT-4 codes, included medical and surgical complications and re-operation rates.

Results

Seven hundred and ninety-four women underwent open and 176 underwent laparoscopic (including robotic) sacrocolpopexy. Laparoscopic sacrocolpopexy was associated with a significantly increased rate of re-operation for anterior vaginal wall prolapse (3.4 % vs 1.0 %, p = 0.018). However, more medical (primarily cardiopulmonary) complications occurred post-operatively in the open group (31.5 % vs 22.7 %, p = 0.023). When sacrocolpopexy was performed with concomitant hysterectomy, mesh-related complications were significantly higher in the laparoscopic group (5.4 % vs 0 %, p = 0.026).

Conclusion

Laparoscopic sacrocolpopexy resulted in an increased rate of reoperation for prolapse in the anterior compartment. When hysterectomy was performed at the time of sacrocolpopexy, the laparoscopic approach was associated with an increased risk of mesh-related complications.

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Conflicts of interest

J. Quentin Clemens is a consultant for Medtronic, Afferent Pharmaceuticals, and Amphora Medical. None of the other authors has any financial disclaimers/conflicts of interest.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Patient-Oriented Research Career Development Award (1 K23 DK080227, JTA), and an American Recovery and Reinvestment Act (ARRA) Supplement (5K23DK080227).

Author information

Authors and Affiliations

  1. Department of Urology, UCLA, Los Angeles, CA, USA

    Aqsa Khan

  2. Female Pelvic Medicine and Reconstructive Surgery, UCSD, San Diego, CA, USA

    Marianna Alperin

  3. United BioSource Corporation, Lexington, MA, USA

    Ning Wu & Chris L. Pashos

  4. Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA

    J. Quentin Clemens

  5. UCLA School of Medicine, Los Angeles, CA, USA

    Emily Dubina

  6. Department of Surgery/Division of Urology, Cedars-Sinai Medical Center, 99 La Cienega Boulevard, #307, Beverly Hills, CA, 90211, USA

    Jennifer T. Anger

Authors
  1. Aqsa Khan
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  2. Marianna Alperin
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  3. Ning Wu
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  4. J. Quentin Clemens
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  5. Emily Dubina
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  6. Chris L. Pashos
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  7. Jennifer T. Anger
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Corresponding author

Correspondence to Jennifer T. Anger.

Additional information

Clinical Essay Contest Winner, 2011 Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Annual Meeting

Appendix

Appendix

ICD-9 diagnosis and procedure codes and CPT-4 procedure codes for complications

ICD-9

CPT-4 procedure

Surgical

  Diagnosis

49000 Exploratory laparotomy; 50392 percutaneous nephrostomy tube placement; 50780 ureteroneocystostomy; 51800 revision of bladder/urethra; 51860 cystorrhaphy, suture of bladder wound; 57200 colporrhaphy, suture of injury of vagina; 57210 colpoperineorrhaphy, suture of injury of vagina/perineum; 52332 insertion of ureteral stent; 57200 colporrhaphy, suture of injury of vagina; 58520 hysterorrhaphy, repair of ruptured uterus

    553.21 Incisional hernia; 569.83 perforation of rectum; 596.6 rupture of bladder, nontraumatic; 596.9 unspecified disorder of bladder; 998.2 accidental puncture or laceration during a procedure; 998.3 disruption of operative wound; 998.8 other specified complication of procedures not elsewhere classified; 998.9 unspecified complication of procedure not elsewhere classified; 593.3 stricture or kinking of ureter (post-operative); 902.5, 902.50–902.59 injury to iliac blood vessels; 902.8, 902.81–902.89 injury to other specified blood vessels of abdomen and pelvis; 902.9 injury of blood vessels of abdomen/pelvis; 997.5 urinary complications

  Procedure

  54.11 Exploratory laparotomy; 55.02 percutaneous nephrostomy tube placement; 56.74 ureteroneocystostomy; 57.81 cystorrhaphy, suture of bladder wound; 70.71 colporrhaphy, suture of injury of vagina

Bleeding

  Diagnosis

36430 Blood transfusion

    285.9 Anemia; 569.3 hemorrhage of rectum and anus; 569.4 rupture/bleeding/ulcer of rectum; 596.7 hemorrhage into bladder wall; 599.7 hematuria; 624.5 hematoma of vulva; 665.7 pelvic hematoma; 997.2 peripheral vascular complications; 998.1 hemorrhage or hematoma complicating a procedure; 998.10 hemorrhage complicating a procedure; 998.12 hematoma complicating a procedure; 999.80 transfusion reaction, unspecified; 999.2 other vascular complications

  Procedure

    99.00 Blood transfusion

Infection/Inflammation

  Diagnosis

51080 Drainage of perivesical or prevesical space abscess

    590.10 Acute pyelonephritis without lesion of renal medullary necrosis; 590.80 pyelonephritis unspecified; 590.9 kidney infection unspecified; 595 cystitis; 595.0 acute cystitis; 595.3 trigonitis; 595.89 other types of cystitis; 595.9 cystitis unspecified; 597.0 abscess of urethra; 599.0 urinary tract infection, site not specified; 780.6 fever; 616.10 vaginitis and vulvovaginitis, unspecified; 616.11 vaginitis and vulvovaginitis; 616.8 other inflammatory disease of cervix, vagina, vulva; 616.81 mucositis of vulva, vagina, or cervix; 616.89 other inflammatory disease of vulva, vagina, or cervix; 616.9 unspecified inflammatory disease of vulva, vagina, cervix; 958.3 post-traumatic wound infection not otherwise specified; 998.5 post-operative infection; 998.51 post-operative seroma; 998.59 other post-operative infection

Pelvic pain

  ICD-9 diagnosis

    625 Dyspareunia; 625.1 vaginismus; 635.7 vulvodynia; 625.8 other specified symptoms associated with female genital organs; 625.9 unspecified symptom associated with female genital organs; 789.9 vesical pain, tenesmus

Urinary retention

  Diagnosis

51040 Cystostomy, cystotomy with drainage; 51701 urethral/bladder catheterization (simple); 52270 cystourethroscopy with internal urethrotomy, female; 52281 cystourethroscopy with dilation of stricture; 52285 cystourethroscopy with dilation with or without urethrotomy; 53620 dilation of urethral stricture; 53660/53661/53665 dilation of female urethral stricture

    596.0 Bladder neck obstruction; 599.6 urinary obstruction; 788.2 retention of urine; 788.21 incomplete bladder emptying; 788.29 other specified retention of urine; 788.38 overflow incontinence; 788.62 slowing of urinary stream

  Procedure

    57.1 Cystostomy; 57.94 urethral/bladder catheterization (simple); 58.0 cystourethroscopy with internal urethrotomy, female; 58.6 urethral dilation

Mechanical device

  Diagnosis

57295 revision (including removal) of prosthetic vaginal graft (vaginal); 57296 revision (including removal) of prosthetic vaginal graft (abdominal); 57426 revision (including removal) of prosthetic vaginal graft (laparoscopic); 57287 removal or revision of sling

    996.3 Mechanical complication of genitourinary device, implant, and graft; 996.30 mechanical complication of unspecified genitourinary device, implant, and graft; 996.39 other mechanical complication of GU device, implant, and graft; 996.6 infection and inflammatory reaction due to internal prosthetic device implant and graft; 996.64 infection and inflammatory reaction due to indwelling urinary catheter; 996.65 infection and inflammatory reaction due to other GU device, implant, and graft; 996.69 infection and inflammatory reaction due to other internal prosthetic device, implant, and graft; 996.76 other complication of internal (biological/synthetic) prosthetic device, implant, and graft

  Procedure

    58.5 Removal or revision of sling

Fistula

  Diagnosis

51900 Closure of vesicovaginal fistula (abdominal); 51920 closure of vesicouterine fistula; 51925 closure of vesicouterine fistula with hysterectomy; 57300 closure of rectovaginal fistula (vaginal, transanal); 57305 closure of rectovaginal fistula (abdominally); 57307 closure of rectovaginal fistula (abdominal) and colostomy; 57308 closure of rectovaginal fistula (transperineal); 57310, 57311 closure of urethrovaginal fistula; 57320 closure of vesicovaginal fistula (vaginal); 57330 closure of vesicovaginal fistula (transvesical, vaginal)

    565.1 Anal fistula; 596.1 intestinovesical fistula; 596.2 urethrovesical fistula; 599.1 urethral fistula; 619 vesicovaginal fistula, urethrovesical fistula; 998.6 persistent post-operative fistula

  Procedure

    57.84 Closure of vesicovaginal fistula; 58.43 closure of urethrovaginal fistula

Medical/non-urological

  ICD-9 diagnosis

    402.01 Malignant hypertensive heart disease with heart failure; 402.11 benign hypertensive heart disease with heart failure; 402.91 unspecified hypertensive heart disease with heart failure; 410 acute myocardial infarction; 410.0, 410.00, 410.01, 410.02 anterolateral wall MI; 410.1, 410.10, 410.11, 410.12 anterior wall MI; 410.2, 410.20, 410.21, 410.22 inferolateral wall MI; 410.3, 410.30, 410.31, 410.32 inferoposterior wall MI; 410.4, 410.40, 410.41, 410.42 inferior wall MI; 410.5, 410.50, 410.51, 410.52 lateral wall MI; 410.6, 410.60, 410.61, 410.62 posterior wall MI; 410.7, 410.70, 410.71, 410.72 subendocardial MI; 410.8, 410.80, 410.81, 410.82 acute other specified site MI; 410.9, 410.90, 410.91, 410.92 acute unspecified site MI; 427.5 cardiac arrest; 428 heart failure; 428.0 CHF unspecified; 428.1 left heart failure; 428.2, 428.20, 428.21, 428.22, 428.23 systolic heart failure; 428.3, 428.30, 428.31, 428.32, 428.33 diastolic heart failure; 428.4, 428.40, 428.41, 428.42, 428.43 combined systolic/diastolic heart failure; 428.9 heart failure unspecified; 785.51 cardiogenic shock; 997.1 cardiac complications not elsewhere classified; 415.1 pulmonary embolism and infarction; 466, 466.0, 466.1 acute bronchitis and bronchiolitis; 480, 480.0, 480.1, 480.2, 480.3, 480.8, 480.9 viral pneumonia; 481 pneumococcal pneumonia; 482, 482.1–482.9 other bacterial pneumonia; 483, 483.0, 483.1, 483.8 pneumonia due to other specified organism; 485 bronchopneumonia organism unspecified; 486 pneumonia organism unspecified; 507.0 pneumonitis due to inhalation of food or vomitus; 511, 511.0, 511.1, 511.8, 511.9 pleural effusion or pleurisy; 518.0 pulmonary collapse; 518.4 pulmonary edema; 518.5 pulmonary insufficiency following trauma and surgery; 518.81 acute respiratory failure; 518.82 other pulmonary insufficiency not elsewhere classified; 799.1 respiratory failure/arrest; 997.3 respiratory complications

    433 Occlusion and stenosis of precerebral arteries; 433.0, 433.00, 433.01 occlusion and stenosis of basilar artery

    433.1, 433.10, 433.11 Occlusion and stenosis of carotid artery; 433.2, 433.20, 433.21 occlusion and stenosis of vertebral artery; 433.3, 433.30, 433.21 occlusion and stenosis of multiple and bilateral precerebral arteries; 433.8, 433.80, 433.81 occlusion and stenosis of other specified precerebral artery; 433.9, 433.90, 433.91 occlusion and stenosis of unspecified precerebral artery; 434 occlusion of cerebral arteries; 434.0, 434.00, 434.01 cerebral thrombosis; 434.1, 434.10, 434.11 cerebral embolism; 434.9, 434.90, 434.91 cerebral artery occlusion unspecified

    436 Acute but ill-defined cerebrovascular disease; 437, 437.0–437.9 other and ill-defined cerebrovascular disease; 444.2 embolism and thrombosis of arteries of the extremities; 444.22 arterial embolism and thrombosis of lower extremity; 444.81 embolism and thrombosis of iliac artery; 451.1 thrombophlebitis of deep veins of lower extremities; 451.2 phlebitis and thrombophlebitis of lower extremities unspecified; 451.81 phlebitis and thrombophlebitis of iliac vein; 451.9 phlebitis and thrombophlebitis of unspecified site; 453.8 acute venous embolism and thrombosis of other specified veins; 560.1 paralytic ileus; 560.8 other unspecified intestinal obstruction; 560.81 intestinal or peritoneal adhesions with obstruction (post-operative, post-infection); 560.89 other specified intestinal obstruction; 560.9 unspecified intestinal obstruction; 997.4 GI complications/bowel obstruction

    584, 584.5, 584.6, 584.7, 584.8, 584.9 Acute kidney failure; 586 renal failure unspecified; 785.5 shock without mention of trauma; 785.50 shock unspecified; 785.52 septic shock; 785.59 other shock without trauma; 995.0 anaphylactic shock; 995.4 shock due to anesthesia; 998.0 post-operative shock not elsewhere classified; 999.4 anaphylactic shock due to serum not elsewhere classified; 798 sudden death cause unknown; 798.1 instantaneous death; 798.2 death occurring less than 24 h from onset of symptoms not otherwise explained; 798.2 unattended death

  1. GU genitourinary, MI myocardial infarction, CHF congestive heart failure, GI gastrointestinal

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Khan, A., Alperin, M., Wu, N. et al. Comparative outcomes of open versus laparoscopic sacrocolpopexy among medicare beneficiaries. Int Urogynecol J 24, 1883–1891 (2013). https://doi.org/10.1007/s00192-013-2088-9

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  • DOI: https://doi.org/10.1007/s00192-013-2088-9

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