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Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin.

Publication ,  Journal Article
Luchristt, D; Zemtsov, G; Jelovsek, JE
Published in: Female Pelvic Med Reconstr Surg
June 1, 2022

OBJECTIVES: To assess the association of publication of the American Urogynecologic Society (AUGS)/American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on pelvic organ prolapse and performance of an apical suspension at the time of surgery for pelvic organ prolapse. METHODS: Surgical procedures performed with a primary diagnosis of uterovaginal or female genital prolapse, cystocele, or enterocele were isolated from the 2011 to 2019 American College of Surgeons National Surgical Quality Improvement Program Database. An autoregressive interrupted time series regression estimated the overall temporal trend in performance of an apical suspension and assessed for a change in trend associated with publication of the AUGS/ACOG Practice Bulletin in April 2017. A stratified analysis was also performed depending on performance of a concomitant hysterectomy, and sensitivity analysis was performed using only diagnoses of uterovaginal or vaginal vault prolapse. RESULTS: There were 72,194 individuals identified; 83.4% had a diagnosis of uterovaginal or female genital prolapse, 15.2% cystocele and 1.4% enterocele. Only 36.6% of cases had an apical suspension. Prior to the practice bulletin publication, performance of an apical suspension grew at 0.19% per quarter (95% confidence interval [CI], 0.07-0.31), with a trend toward increased utilization (+0.12%; 95% CI, -0.06 to 0.30) after publication. The increase was greater among cases with a concomitant hysterectomy (+0.35%; 95% CI, 0.08-0.62). Sensitivity analyses found similar changes in trend. CONCLUSIONS: Performance of apical suspensions during surgery for prolapse remains low and is increasing at less than 1% per year. The AUGS/ACOG practice guidelines were associated with minimal changes in this pattern. Incentives or other strategies may be needed to further encourage standard of care management of prolapse.

Duke Scholars

Published In

Female Pelvic Med Reconstr Surg

DOI

EISSN

2154-4212

Publication Date

June 1, 2022

Volume

28

Issue

6

Start / End Page

367 / 371

Location

United States

Related Subject Headings

  • United States
  • Suspensions
  • Pelvic Organ Prolapse
  • Hysterectomy
  • Humans
  • Hernia
  • Gynecologic Surgical Procedures
  • Female
  • Cystocele
  • 3215 Reproductive medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Luchristt, D., Zemtsov, G., & Jelovsek, J. E. (2022). Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin. Female Pelvic Med Reconstr Surg, 28(6), 367–371. https://doi.org/10.1097/SPV.0000000000001136
Luchristt, Douglas, Gregory Zemtsov, and J Eric Jelovsek. “Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin.Female Pelvic Med Reconstr Surg 28, no. 6 (June 1, 2022): 367–71. https://doi.org/10.1097/SPV.0000000000001136.
Luchristt, Douglas, et al. “Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin.Female Pelvic Med Reconstr Surg, vol. 28, no. 6, June 2022, pp. 367–71. Pubmed, doi:10.1097/SPV.0000000000001136.

Published In

Female Pelvic Med Reconstr Surg

DOI

EISSN

2154-4212

Publication Date

June 1, 2022

Volume

28

Issue

6

Start / End Page

367 / 371

Location

United States

Related Subject Headings

  • United States
  • Suspensions
  • Pelvic Organ Prolapse
  • Hysterectomy
  • Humans
  • Hernia
  • Gynecologic Surgical Procedures
  • Female
  • Cystocele
  • 3215 Reproductive medicine