title: Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010.
abstract: OBJECTIVE
  To describe trends in and predictors of surgical mesh use for pelvic organ prolapse (POP) repair and to estimate the influence of safety advisories on mesh use.
  
  
  METHODS
  Analysis of women aged 18 years and older recorded in a health care quality and resource utilization database who underwent POP repair from 2000 to 2010, identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure codes, and stratified by mesh use. Odds ratios were calculated with adjustments for patient, physician, and hospital-level characteristics.
  
  
  RESULTS
  Among 273,275 women in the cohort, 64,968 (23.8%) underwent a mesh-augmented repair. Concurrent incontinence surgery was a strong predictor of mesh use (odds ratio [OR] 9.95; 95% confidence interval [CI] 9.70-10.21). Mesh use increased from 7.9% in 2000 to a peak of 32.1% in 2006, and declined slightly to 27.5% in 2010. Among women without incontinence, mesh use increased from 3.3% in 2000 to 13.5% in 2006, and remained stable at 12.8% in 2010. Intermediate-volume (OR 1.53; 95% CI 1.44-1.62) and high-volume (OR 2.74; 95% CI 2.58-2.92) surgeons were more likely to use mesh than low-volume surgeons. Compared with women who underwent operation by gynecologists, those treated by urologists were more than three times more likely to undergo mesh-augmented prolapse repair (OR 3.36; 95% CI 3.09-3.66). Black women were 27% less likely to undergo mesh repair (OR 0.73; 95% CI 0.66-0.82).
  
  
  CONCLUSIONS
  Mesh-augmented prolapse repairs increased substantially over the past decade, and this increase was most pronounced in the years before the publication of safety advisories. Physician specialty and surgical volume are important factors underlying mesh use. Additional measures must ensure evidence-based use of mesh for pelvic reconstruction.
  
  
  METHODS
  II.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-7366, USA. lrogogupta@mednet.ucla.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Rogo-Gupta
authors.forename: Larissa V
authors.initials: LV
authors.lastname: Rodriguez
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Shlomo
authors.initials: S
authors.lastname: Raz
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D013526:Surgical Mesh / Q000639:trends*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000601:surgery*