Cost of Pelvic Organ Prolapse Surgery in the United States

Subak, Leslee L.; Waetjen, L. Elaine; Eeden, Stephen Van Den; Thom, David H.; Vittinghoff, Eric; Brown, Jeanette S.

doi:10.1097/00006250-200110000-00021

Cited by 80 publications

(90 citation statements)

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“…2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterectomy vaginal vault prolapse.…”

Section: Discussionmentioning

confidence: 99%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE:We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN:This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS:In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2e38.6), which included 20.3% (95% CI, 17.9e23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6e1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4e6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6e3.5) and 0.8% (95% CI, 0.4e1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02e0.6) and 0.8% (95% CI, 0.4e1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4e16.8): 10.6% (95% CI, 8.8e12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2e13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4e4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION:Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse. P elvic organ prolapse (POP) is a common problem in women and is associated with considerable morbidity and a decreased quality of life. In the United States, the prevalence of POP is approximately 2.9% 1 and nearly 300,000 women undergo surgery annually for prolapse. 2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterec...

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Section: Discussionmentioning

confidence: 99%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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Section: Introductionmentioning

confidence: 99%

“…In 1997, the direct costs for pelvic organ prolapse surgery in the USA were estimated as $1012 million with 21% of these procedures being combined with a continence operation. 4 When considering outcome measures, there has been a paucity of data regarding patient expectations following treatment for urogenital prolapse. Expectations regarding outcome are shaped by previous personal experiences, those of friends and relatives and also by the attitude and experience of clinicians caring for these women.…”

Section: Introductionmentioning

confidence: 99%

“…In 1997, the direct costs for pelvic organ prolapse surgery in the USA were estimated as $1012 million with 21% of these procedures being combined with a continence operation. 4 When considering outcome measures, there has been a paucity of data regarding patient expectations following DOI: 10.1111/j.1471-0528.2008.01842.x www.blackwellpublishing.com/bjog Urogynaecology treatment for urogenital prolapse. Expectations regarding outcome…”

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confidence: 99%

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Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration

Srikrishna

Robinson

Cardozo

et al. 2008

BJOG

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Objective To explore the expectations and goals of women undergoing surgery for urogenital prolapse using both a quantitative quality of life approach exploring symptom bother and a qualitative interview-based approach exploring patient goals and expectations.Design Prospective observational study.Setting Tertiary referral centre for urogynaecology.Population Forty-three women with symptomatic pelvic organ prolapse were recruited from the waiting list for pelvic floor reconstructive surgery.Methods All women were assessed with a structured clinical interview on an individual basis. The data obtained were transcribed verbatim and then analysed thematically based on the grounded theory. Individual codes and subcodes were identified to develop a coding framework. The prolapse quality-of-life (pQoL) questionnaire was used to determine the impact of pelvic organ prolapse on the woman's daily life. We arbitrarily classified 'bother' as minimal, mild, moderate and marked if scores ranged from 0 to 25, 25-50, 50-75 and 75-100, respectively. The degree of prolapse was objectively quantified using the pelvic organ prolapse quantification (POP-Q) system. Quantitative data were analysed using SPSS. Ethical approval was obtained from the Kings College Hospital Ethics Committee.Main outcome measures Quantitative data from POP-Q, subjective data from pQoL, qualitative data based on the structured clinical interview.Results Forty-three women were recruited over the first 1 year of the study. Their mean age was 56 years (range 36-78) and mean parity was 2 (range 0-6). The mean ordinal stage of the prolapse was 2 (range stages 1-4). Quantitative analysis of the pQoL data suggested that the main domains affected were prolapse impact on life (mean score 74.71) and personal relationships (mean score 46.66). Qualitative analysis based on the clinical interview suggested that these women were most affected by the actual physical symptoms of prolapse (bulge, pain and bowel problems) as well by the impact prolapse has on their sexual function.Conclusions While disease-specific QoL questionnaires allow broad comparisons to be made assessing patient bother, they may lack the sensitivity to assess individual symptoms. A qualitative approach may individualise patient care and ultimately improve patient satisfaction and overall outcome when treating women complaining of urogenital prolapse.Keywords Grounded theory, prolapse, qualitative analysis, quality of life. IntroductionUrogenital prolapse, while not life threatening, remains an important cause of morbidity in women and the effect on quality of life (QoL) has been extensively documented. 1 Increased life expectancy and an expanding elderly population means that urogenital prolapse remains an important condition particularly since the majority of women may now spend one-third of their lives in the postmenopausal state. 2 In a retrospective cohort study of 149 554 women, the lifetime risk of having surgery for urogenital prolapse was 11%, and 29.2% of women required repeat surgery. 3 The...

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“…Pelvic organ prolapse is a common problem affecting up to 50% of parous women (Subak et al, 2001). Not all of them are symptomatic (Olsen et al, 1997;Baessler and Maher, 2006), and the risk of requiring surgery for prolapse is 11-12% in women reaching 79 years of age (Olsen et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Incidence of Early Postoperative Infections between Patients Using Synthetic Mesh and Those Undergoing Traditional Pelvic Reconstructive Surgical Procedures

et al. 2013

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R e c e i ve d Ju ly 2 , 2 0 1 2 ; A c c e p t e d A p r i l 8 , 2 0 1 3 . Key words: Febrile morbidity -Pelvic organ prolapse -Postoperative infectionsSepsis -Synthetic polypropylene meshAbstract: New mesh-related complications such as erosion, etc., can result from abnormal postoperative healing due to surgical site infection. The aim of our study was to compare systemic inflammatory responses and the incidence of early infectious complications after reconstructive surgery using synthetic mesh and after traditional vaginal wall repair. In this prospective observational study 99 women with symptomatic pelvic organ prolapse were included; 55 women underwent traditional repair and 44 repair using mesh. After the procedure infectious complications were monitored. The patients who underwent reconstructive Republic, and surgery using mesh material were more likely to have febrile morbidity in the postoperative period than the patients who had been treated with traditional repair (p=0.031); there was a higher incidence of combination febrile morbidity with elevated C-reactive protein (CRP) > 50 mg/l; p=0.046, and a higher incidence of CRP increase over 30 mg/l; p=0.005. Reconstructive procedures using synthetic mesh are accompanied by a higher incidence of early post-operative infectious complications. This study was supported by the Grant Agency of the Ministry of Health of the Czech IntroductionPelvic organ prolapse is a common problem affecting up to 50% of parous women (Subak et al., 2001). Not all of them are symptomatic (Olsen et al., 1997;Baessler and Maher, 2006), and the risk of requiring surgery for prolapse is 11-12% in women reaching 79 years of age (Olsen et al., 1997). For a long time traditional pelvic reconstruction surgical procedures were the only ones available. The longterm efficiency of those procedures varied, and re-operation rates of nearly 30% have been reported by Olsen et al. (1997), with a risk of recurrence of up to 45% according to Valaitis and Stanton (1994) and Kohli et al. (1998). This may be one of the reasons why synthetic meshes were introduced to pelvic reconstructive surgery. However, these new surgical procedure have brought with them new mesh-related complications such as erosion, pain syndrome, etc. as described by Bako and Dhar (2009). Some of these complications -erosion, shrinkage and abnormal pain -can result from abnormal postoperative healing due to surgical site infection.The vagina contains more microorganisms than any other site in the body except the bowel (Lamont and Haynes, 2008). Surgical procedures resulting in the opening of the vagina will result in contamination of normally sterile sites by bacteria that are normally resident in the vagina. Infection and inflammation depends on a mixture of surgical and host-related factors. When mesh material is used this decreases the size of the bacterial inoculum, which can induce postoperative infection.The aim of our study was to compare immediate inflammatory reaction and the incidence of infectious complications afte...

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Cost of Pelvic Organ Prolapse Surgery in the United States

Cited by 80 publications

References 5 publications

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration

A Comparison of the Incidence of Early Postoperative Infections between Patients Using Synthetic Mesh and Those Undergoing Traditional Pelvic Reconstructive Surgical Procedures

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