Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Am J Obstet Gynecol. 2014 Sep;211(3):222.e1-5. doi: 10.1016/j.ajog.2014.04.002. Epub 2014 Apr 5.
Recent evidence supports improved outcomes in women who undergo an incontinence procedure at the time of apical prolapse repair compared with apical repair alone. Our primary objective was to describe national trends in concomitant apical repair and incontinence procedures that were performed in the United States from 2001-2009. A secondary objective was to describe complications and length of stay.
We used the Nationwide Inpatient Sample to collect data on hospital discharges for women who had inpatient apical prolapse surgery from 2001-2009. We included women whose records included the International Classification of Disease-9 Clinical Modification procedure codes for apical procedures with and without incontinence procedures. We examined annual trends in the proportion of concomitant procedures using chi-square testing and multiple logistic regression.
Of all apical procedures, the percentage of concomitant incontinence procedures performed increased from 37.9% in 2001 to 47% in 2009 (P = .0002 for trend). In-hospital complications (hemorrhage, bowel obstruction, and/or abscess) were less common with concomitant procedures (6.8% vs 11.7%; P = .02). All geographic regions had increasing trends of concomitant incontinence procedures with no difference among regions (P = .7 for interaction). Both community and academic institutions had increasing trends of concomitant procedures over the study period, with no difference among the types of institutions. Age was not associated with increasing trends in concomitant procedures.
The proportion of concomitant apical and incontinence procedures increased in the United States from 2001-2009. Length of stay was slightly longer for the concomitant group, but complications were not increased.
最近的证据表明，与单独进行 apical 修复相比，在 apical 脱垂修复时同时进行失禁手术的女性结局得到改善。我们的主要目的是描述 2001-2009 年美国同时进行 apical 修复和失禁手术的全国趋势。次要目的是描述并发症和住院时间。
我们使用全国住院患者样本，收集 2001-2009 年因 apical 脱垂住院手术的女性患者的医院出院数据。我们纳入了记录中有 apical 手术的国际疾病分类-9 临床修正程序代码且包含有无失禁手术的女性患者。我们使用卡方检验和多因素逻辑回归分析，检查同时进行的程序的年度比例趋势。
在所有 apical 手术中，同时进行失禁手术的比例从 2001 年的 37.9%增加到 2009 年的 47%（趋势 P 值=0.0002）。同时进行手术的患者发生院内并发症（出血、肠梗阻和/或脓肿）的可能性较低（6.8% vs 11.7%；P=0.02）。所有地理区域的同时进行失禁手术的趋势都在增加，但各区域之间没有差异（交互作用 P 值=0.7）。在研究期间，社区和学术机构都有同时进行手术的趋势，机构类型之间没有差异。年龄与同时进行手术的趋势无关。
2001-2009 年，美国同时进行 apical 和失禁手术的比例增加。同时进行手术组的住院时间略长，但并发症没有增加。
