39: Does specialization in female pelvic medicine and reconstructive surgery affect procedure type for vaginal repair of pelvic organ prolapse?

Abstract

To determine if specialization in female pelvic medicine and reconstructive surgery (FPMRS) affects type of vaginal reconstructive procedures utilized in treatment of pelvic organ prolapse (POP). This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2016. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) with a postoperative diagnosis of POP who underwent vaginal hysterectomy with any combination of pelvic reconstructive procedures. Propensity scores calculated using preoperative data was utilized to match groups by specialty at ratio of 1:2 (FPMRS to obstetrician/gynecologists) to ameliorate selection bias. Pairwise analysis using Student’s t-test and Fisher’s exact test was performed where appropriate. After propensity score matching there were 927 cases performed by FPMRS and 1,853 performed by obstetrician-gynecologists (OBG). Uterovaginal prolapse was the most common indication surgery in both groups, 88.3% for FPMRS and 85.1% for OBG, based on the most commonly utilized diagnostic codes. The cohorts were well matched with no differences in pre-operative characteristics, however, the cohorts differed on nearly all intraoperative variables (Table 1). Most notably, OBGs were less likely to perform apical repair (33.4% vs 82.5%, p<0.001) and were more likely than FPMRS to perform vaginal hysterectomy alone (53.2% vs 7.0%, p<0.001). The most common apical suspension performed in both groups was intraperitoneal colpopexy, 70.3% and 28.9% in the FPMRS and OBG groups respectively; colpocleisis with hysterectomy was the least common, 1.1% and 0.4% for FPMRS and OBG, respectively. The majority of patients undergoing surgery by either groups underwent a sling procedure, and FPMRS were more likely to place slings (75.0% vs 65.3%, p<0.001). FPMRS surgeons were more likely to perform intraoperative cystoscopy (82.9% vs 72.0%, p<0.001). The complication rate was higher in the FPMRS group, 9.1% vs 6.4%, p=0.01. This difference was primarily due to a higher urinary tract infection rate, 5.9% vs 3.4%, p=0.001. There were no other significant differences in rates of specific complications. Sub-specialization in FPMRS is associated with a higher rate of apical support procedures at the time of vaginal hysterectomy for pelvic organ prolapse.View Large Image Figure ViewerDownload Hi-res image Download (PPT)