2141 OUTCOMES OF VAGINAL PROLAPSE SURGERY AMONG FEMALE MEDICARE BENEFICIARIES: THE ROLE OF APICAL SUPPORT

Abstract

MPHOBJECTIVE: Recurrent pelvic organ prolapse (POP) hasbeen attributed to many factors, one of which is lack ofvaginal apical support. To assess the role of vaginal apicalsupport and POP, we analyzed a national dataset tocompare long-term reoperation rates after prolapsesurgery performed with and without apical support.METHODS: Public use file data on a 5% random nationalsample of female Medicare beneficiaries were obtainedfrom the Centers for Medicare and Medicaid Services.Women with POP who underwent surgery during 1999were identified by relevant International Classification ofDiseases, 9th Revision, Clinical Modification, and CurrentProcedural Terminology, Fourth Edition codes. Individualpatients were followed-up through 2009. Prolapse repairwas categorized as anterior, posterior, or anterior–posteriorwith or without a concomitant apical suspension procedure.TheprimaryoutcomewastherateofretreatmentforPOP.RESULTS: In 1999, 21,245 women had a diagnosis ofPOP. Of these, 3,244 (15.3%) underwent prolapse surgerythat year. There were 2,756 women who underwent ananterior colporrhaphy, posterior colporrhaphy, or bothwith or without apical suspension. After 10 years, cumu-lative reoperation rates were highest among women whohad an isolated anterior repair (20.2%) and significantlyexceeded reoperation rates among women who hada concomitant apical support procedure (11.6%; P,.01).CONCLUSION: Ten years after surgery for POP, thereoperation rate was significantly reduced when a con-comitant apical suspension procedure was performed.This analysis of a national cohort suggests that theappropriate use of a vaginal apical support procedureat the time of surgical treatment of POP might reduce thelong-term risk of prolapse recurrence.