Abstract
Introduction and hypothesisGreat variety in clinical management of pelvic organ prolapse (POP) has been described over the last years. Practice pattern variation (PPV) reflects differences in care that cannot be explained by the underlying condition. We aim to explore whether PPV in management of POP in The Netherlands has changed between 2011 and 2017.MethodsWe conducted a multicenter cohort study, using prospective routinely collected benchmark data from LOGEX, a healthcare analytics company (Amsterdam, The Netherlands). Data of patients with a diagnosis POP from 50 hospitals (16 teaching and 34 non-teaching hospitals) were collected for the years 2011 and 2017. All treatments were categorized into three groups: conservative treatment, uterus-preserving or uterus-removing surgery. Using meta-analysis, we evaluated whether the proportions of conducted treatments changed over time and estimated the between-center variation (Cochran’s Q), reflecting the PPV in 2011 and 2017. This variation was analyzed using F-tests.ResultsCompared to 2011, referral for POP in 2017 decreased by 16.2% (−4505 patients), and the percentage of hysterectomies decreased by 33.6% (p < 0.0001). The PPV of POP surgery decreased significantly by 47.2% (p = 0.0137) and of hysterectomies by 41.5% (p = 0.0316).ConclusionsWe found a decline in PPV for POP surgery between 2011 and 2017. Furthermore, the number of surgical interventions decreased, which was mostly due to a decline of hysterectomies. This indicates a shift toward more conservative therapy and uterus preservation. A further reduction of PPV would be beneficial for the quality of health care.
Highlights
Introduction and hypothesisGreat variety in clinical management of pelvic organ prolapse (POP) has been described over the last years
Percentage of POP surgery represents the number of surgical therapies within the G25 care product c Range: minimum–maximum d Percentage of hysterectomies is presented as percentage of total number of POP surgeries
P value for subgroup differences between teaching and non-teaching hospitals: p = 0.225 for POP surgery; p = 0.177 for hysterectomy hysterectomies decreased with 33.6% [95% confidence interval (CI) –38.9 to −27.7, p < 0.0001]
Summary
Introduction and hypothesisGreat variety in clinical management of pelvic organ prolapse (POP) has been described over the last years. Using meta-analysis, we evaluated whether the proportions of conducted treatments changed over time and estimated the between-center variation (Cochran’s Q), reflecting the PPV in 2011 and 2017. The number of surgical interventions decreased, which was mostly due to a decline of hysterectomies. This indicates a shift toward more conservative therapy and uterus preservation. Surgery is offered to women whose symptoms do not improve with conservative treatment or who prefer surgical therapy [3]. Apart from symptoms, type and severity of the prolapse, the experience and
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