Division of FPMRS, 3219 Clifton Avenue, Suite 100, Cincinnati, OH, 45220, USA.
Int Urogynecol J. 2020 Jul;31(7):1349-1355. doi: 10.1007/s00192-020-04281-w. Epub 2020 Apr 2.
To describe national practice patterns regarding apical support procedures at time of hysterectomy for prolapse prior to the American College of Obstetricians and Gynecologists (ACOG) 2017 Practice Bulletin on pelvic organ prolapse.
This retrospective descriptive study analyzed 24 months of data from the National Surgical Quality Improvement Program (NSQIP) database, from 2015 and 2016. Patients undergoing hysterectomy for the indication of pelvic organ prolapse were included. Surgical details, diagnostic codes, subspecialty, patient demographics, and postoperative complications were collected. Comparisons were conducted between those who did and did not undergo apical support procedures. Further comparisons, including logistic regressions, were performed using subspecialty designation.
During the study period, 3458 hysterectomies were performed for the indication of pelvic organ prolapse. Of this population, 76% were White, with an average age of 61 years, BMI of 27.6, and parity of 2, and 90.5% carried the diagnosis of apical prolapse. Slightly over half (51.8%) had a concurrent procedure to support the vaginal apex. When performed by Female Pelvic Medicine and Reconstructive Surgery (FPMRS) physicians, 65.7% underwent an apical suspension at time of hysterectomy for prolapse compared with 40.2% of non-FPMRS (p < 0.001). Annual rates of apical support procedures showed significant improvement from 49.5% in 2015 to 55.2% in 2016 (P < 0.001). Regarding surgical data, addition of apical support procedures increased operative time by 33 min, and reoperation was 1.3% higher (0.3% vs 1.6%).
Our results demonstrate that in the 2 years prior to ACOG's recommendation only 51.8% of women undergoing hysterectomy for pelvic organ prolapse received concurrent procedures to address apical support.
在 2017 年美国妇产科医师学会（ACOG）盆腔器官脱垂实践公告之前，描述在进行脱垂子宫切除术时有关顶端支撑手术的国家实践模式。
这项回顾性描述性研究分析了国家手术质量改进计划（NSQIP）数据库中 2015 年和 2016 年的 24 个月数据。纳入接受子宫切除术治疗盆腔器官脱垂的患者。收集了手术细节、诊断代码、亚专业、患者人口统计学和术后并发症。比较了进行和未进行顶端支撑手术的患者。使用亚专业指定进行了进一步的比较，包括逻辑回归。
在研究期间，3458 例因盆腔器官脱垂而行子宫切除术。在这一人群中，76%为白人，平均年龄为 61 岁，BMI 为 27.6，孕次为 2，90.5%诊断为顶端脱垂。略多于一半（51.8%）有同时进行的手术来支撑阴道顶端。当由女性盆底医学和重建外科医生（FPMRS）进行时，65.7%的患者在因脱垂而行子宫切除术时进行了顶端悬吊术，而非 FPMRS 的比例为 40.2%（p<0.001）。从 2015 年的 49.5%到 2016 年的 55.2%，顶端支撑手术的年度实施率显著提高（P<0.001）。关于手术数据，增加顶端支撑手术将手术时间延长了 33 分钟，再次手术率增加了 1.3%（0.3%对 1.6%）。
我们的结果表明，在 ACOG 建议之前的 2 年中，仅有 51.8%的因盆腔器官脱垂而行子宫切除术的女性接受了同时进行的手术来解决顶端支撑问题。
