SCOTTSDALE, ARIZ. – The number of apical pelvic organ prolapse repairs done each year in the United States has increased, but less invasive approaches have become the norm, a cross-sectional study spanning a 15-year period found.
Using data from the Medstat MarketScan database, which captures information on commercially insured individuals, researchers identified 53,980 women aged 18-65 years who underwent surgery for apical prolapse between 1996 and 2010.
Dr. Vani Dandolu
The results showed that the number of procedures done each year rose steadily during the study period, first author Dr. Vani Dandolu reported at the annual scientific meeting of the Society of Gynecologic Surgeons.
At the same time, there was a decrease in the proportion of procedures done abdominally, from 49% to 12%, and increases in the proportions done laparoscopically (including robotically), from 0% to 21%, and done vaginally, from 51% to 67%.
Among all vaginal procedures, the proportion in which mesh was used increased steadily after its approval in 2002, peaked in 2007, and fell thereafter with the first safety warning about this product by the Food and Drug Administration in 2008. As of 2010, about 18% of vaginal procedures were done with mesh.
"Surgical advances have brought new evolution in the repair of apical prolapse in the past decade," commented Dr. Dandolu, who is professor and chair of obstetrics and gynecology at the University of Nevada in Las Vegas. "Up until 2002, the data was fairly simple: About half the procedures performed were open sacrocolpopexies, and the other half were extraperitoneal vaginal suspensions, mainly sacrospinous fixations. Things changed in the second half of the study period – it became more complex, there was more variety of procedures.
"The proportion of abdominal sacrocolpopexies decreased sharply between 1996 and 2010. This corresponded to an increase in laparoscopic sacrocolpopexy and vaginal procedures, as well as the mesh repairs," she said.
A key advantage of the MarketScan database over other national databases is its high-quality coding, which permits precise categorization of the various types of prolapse repair, noted Dr. Dandolu.
"When you are looking at procedures, probably this is the most robust dataset because it gathers information both from the providers as well as the facilities. The providers typically record the procedures based on CPT [Current Procedural Terminology] procedure codes that are more precise than the facilities’ report based on ICD [International Classification of Diseases] procedure codes," she added.
Session attendee Dr. William Hurd of the Duke Fertility Center in Durham, N.C., asked, "Do you think the increased number of procedures is related to the aging population or to more people trained to do these procedures?"
"I think it’s a combination of several things – the two factors you mentioned, as well as more and more commercial insurers are reporting data into this dataset," Dr. Dandolu replied.
Attendee Dr. John Riggs of the University of Texas in Houston wondered if the CPT codes had changed in any way during the study period.
"The CPT codes for the laparoscopic sacrocolpopexies were introduced around 2003 and the mesh codes were introduced around 2005," Dr. Dandolu replied. "Otherwise, for the traditional procedures, the CPT procedural codes have not changed."
Finally, attendee Dr. Lisa Peacock of Louisiana State University Health Sciences Center in New Orleans asked, "Could you tell in your increase in laparoscopic procedures what proportion of that may be robotic?"
That information was not available as the database did not split out the robotic procedures until 2011, Dr. Dandolu said at the meeting, which was jointly sponsored by the American College of Surgeons.
Dr. Dandolu reported no relevant conflicts of interest.