Practice patterns of general gynecologic surgeons versus gynecologic subspecialists for concomitant apical suspension during vaginal hysterectomy for uterovaginal prolapse.
Practice patterns of general gynecologic surgeons versus gynecologic subspecialists for concomitant apical suspension during vaginal hysterectomy for uterovaginal prolapse.
- 2015
Available online through MWHC library: 2003 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: The majority of prolapse procedures involving hysterectomies performed by general gynecologists do not include apical suspension, whereas urogynecologic subspecialists consistently perform apical suspension. METHODS: Retrospective analysis of the MedStar Health EXPLORYS database for women undergoing transvaginal hysterectomy for prolapse. Appropriate International Classification of Diseases-9 codes for uterine prolapse and incomplete and complete uterovaginal prolapse along with Current Procedural Terminology codes were used to determine frequency of transvaginal hysterectomy alone, transvaginal hysterectomy plus nonapical repair, and transvaginal hysterectomy plus concomitant apical suspension. OBJECTIVES: We hypothesized that subspecialists perform more concomitant apical suspensions during transvaginal hysterectomy for uterovaginal prolapse as compared with general gynecologists. RESULTS: A total of 946 patients underwent vaginal hysterectomy for prolapse, with 5.5 years follow-up. Thirty-five percent (n = 334) underwent transvaginal hysterectomy alone, 20% (n = 184) underwent transvaginal hysterectomy plus nonapical repair, and 45% (n = 428) underwent transvaginal hysterectomy plus apical suspension. Seventy-two percent of patients operated on by general gynecologists compared with 4% of patients operated on by urogynecologists had a transvaginal hysterectomy alone. Only 10% of patients operated on by general gynecologic surgeons compared with 78% operated on by urogynecologists received a concomitant apical suspension for prolapse (P < 0.0001). Forty-four patients (4.7%) required repeat surgery for recurrent prolapse. Because of the small number of repeat surgeries, preoperative degree of prolapse and type of index procedure did not significantly affect the need for repeat surgery.
English
0038-4348
*Gynecology/sn [Statistics & Numerical Data]
*Hysterectomy, Vaginal/mt [Methods]
*Physician's Practice Patterns/sn [Statistics & Numerical Data]
*Uterine Prolapse/su [Surgery]
Adult
Aged
Databases, Factual
Female
Gynecologic Surgical Procedures/mt [Methods]
Humans
Middle Aged
Reoperation/sn [Statistics & Numerical Data]
Retrospective Studies
MedStar Health Research Institute
MedStar Washington Hospital Center
Nursing
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Available online through MWHC library: 2003 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: The majority of prolapse procedures involving hysterectomies performed by general gynecologists do not include apical suspension, whereas urogynecologic subspecialists consistently perform apical suspension. METHODS: Retrospective analysis of the MedStar Health EXPLORYS database for women undergoing transvaginal hysterectomy for prolapse. Appropriate International Classification of Diseases-9 codes for uterine prolapse and incomplete and complete uterovaginal prolapse along with Current Procedural Terminology codes were used to determine frequency of transvaginal hysterectomy alone, transvaginal hysterectomy plus nonapical repair, and transvaginal hysterectomy plus concomitant apical suspension. OBJECTIVES: We hypothesized that subspecialists perform more concomitant apical suspensions during transvaginal hysterectomy for uterovaginal prolapse as compared with general gynecologists. RESULTS: A total of 946 patients underwent vaginal hysterectomy for prolapse, with 5.5 years follow-up. Thirty-five percent (n = 334) underwent transvaginal hysterectomy alone, 20% (n = 184) underwent transvaginal hysterectomy plus nonapical repair, and 45% (n = 428) underwent transvaginal hysterectomy plus apical suspension. Seventy-two percent of patients operated on by general gynecologists compared with 4% of patients operated on by urogynecologists had a transvaginal hysterectomy alone. Only 10% of patients operated on by general gynecologic surgeons compared with 78% operated on by urogynecologists received a concomitant apical suspension for prolapse (P < 0.0001). Forty-four patients (4.7%) required repeat surgery for recurrent prolapse. Because of the small number of repeat surgeries, preoperative degree of prolapse and type of index procedure did not significantly affect the need for repeat surgery.
English
0038-4348
*Gynecology/sn [Statistics & Numerical Data]
*Hysterectomy, Vaginal/mt [Methods]
*Physician's Practice Patterns/sn [Statistics & Numerical Data]
*Uterine Prolapse/su [Surgery]
Adult
Aged
Databases, Factual
Female
Gynecologic Surgical Procedures/mt [Methods]
Humans
Middle Aged
Reoperation/sn [Statistics & Numerical Data]
Retrospective Studies
MedStar Health Research Institute
MedStar Washington Hospital Center
Nursing
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't